ABDOMINAL MYOMECTOMY AND ENUCLEATION FOR FIBROIDS _Abdominal myomectomy._ This signifies the removal of one or more pedunculated subserous fibroids through an incision in the abdominal wall, preserving the uterus, Fallopian tubes, and the ovaries. _Abdominal enucleation._ In this operation a sessile fibroid is shelled out of its capsule: the uterus, ovaries, and tubes are preserved. _Hysterotomy._ In this operation a submucous fibroid is removed, through an incision in the wall of the uterus, which opens the uterine cavity. The preliminary steps for each of these procedures is the same as for ovariotomy, and the Trendelenburg position is of great advantage. After opening the abdomen the intestines are carefully protected by a warm dab, and the tumour carefully examined. When the stalk is narrow it may be transfixed and secured with silk thread, like the pedicle of an ovarian cyst. When the pedicle is short and broad the tumour should be shelled out of its capsule, and any obvious blood-vessel is easily secured with forceps and ligatured with silk. The opposite flaps of the capsule are brought into apposition by mattress sutures, and the redundant portions of the capsule cut away and the free edges carefully brought together by a continuous suture of thin silk. When a fibroid is embedded in the wall of the uterus, the tumour is exposed by cutting through its capsule and seizing it with a volsella; as a rule, it shells out quite easily. This is followed by free bleeding. The vessels are then seized with forceps and ligatured with thin silk. In order to completely control the oozing, mattress sutures are passed through the wall of the capsule on each side, their number varying with the size of the tumour. In some instances a uterus contains ten or more fibroids, and each must be enucleated and the capsule secured with ligatures, as described above. Sometimes the oozing is difficult to control, and the surgeon sutures the edges of the capsule to the lower angle of the incision, and stuffs the cavity or bed of the tumour with gauze. In removing a large submucous tumour through an incision in the wall of the uterus, the surgeon necessarily opens the uterine cavity (hysterotomy). After controlling the bleeding the walls of the uterine incision are closed, as in Cæsarean section. In many instances in which the surgeon attempts to carry out myomectomy or enucleation, he has such difficulty in controlling the oozing that he is driven to remove the uterus.