Reviewer’s report
Title: 
Blood Loss from Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: A
Randomized Controlled Trial
Version: 
3 
Date: 
05 Jul 2020
Reviewer's report:
General comment: Still good work - but unfortunately, the total remake of both crucial parts (Background and
Discussion), have not helped to improve the quality of the paper at all. On the contrary, it made it worse. Less
important details have been corrected properly but it is not enough.
Specific comments:
1. Background (page 9/27): In my opinion, quite good intro into the topic in previous R2 version and just one
comment (from my side) on the relevance of comparison between Caesarean hysterotomy and uterine incision
for myomectomy. This (and also another reviewer´s similar objection) led the authors to make huge and
complete remake of the whole section, which is now too long, too wordy, redundantly over-explicative, and
almost non-understandable to me, i.e. worth than it was before.
2. Material and Methods - Recruitment (page 10/27): My main criticism, that women with single myomas
from 5 cm were treated with open procedure (and not with laparoscopy) and that this fact (which could be
perceived by many like at the edge of the ethics) should be (minimally) explained and stressed in Discussion,
was only replied in the covering letter, saying that the authors had no/low experience with laparoscopic
suturing. It is a bit disappointing and definitely insufficient.
3. Material and Methods - Research Study Outcomes (page 11/27): Post-op pyrexia has been defined as a
"temperature of 38⁰ C in the first 48 postoperative hours and persisting more than 24 hours" .. Why only the
first 2 days? .. What about fever on the 3-rd day post-operatively? .. Would it been estimated as unrelated to
myomectomy? Or was it defined like this according to some relevant source?
4. Results (page 12/27): "Only one case needed postoperative blood transfusion, due to anemic symptoms after
an estimated blood loss of 1000 ml, in the longitudinal incision group, …" But Table 2 (page 20/27) is
showing (in the „longitudinal group") the numbers between 387 and 582 mL - looking like the range, but
described/explained now by the authors as 95% CI (as written in the text of the article). But no one can
understand it (looking at Table 2) because it is not explained either in the Table itself or in the legend.
5. Discussion (page 12-14/27): Unfortunately, the similar problem as in the Background section. Too long,
which makes it almost exhausting for the reader. Especially if we consider that only one and the same
hypothesis (about advantage of transverse incision due to the course of the arteries) has been discussed in more
than 1.5 pages .. and the final result showed the same IBL for both groups. 
This important part especially
should also be read and edited by a native English speaker for fluency and clarity. 
6. Abbreviations (page 15/27): My original (previous) comment to R2 version was: IBL could be added for
intraoperative blood loss. And it was replied by the authors as: Actually, the suggested abbreviation was not
used throughout the manuscript. Yes, it was understood .. and that was why it was recommended to use it
(throughout the text) because it is repeatedly present in the text, as well as common and well-known by many
potential readers even without explanation.
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No
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
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Yes
Are the conclusions drawn adequately supported by the data shown?
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Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional statistical
review?
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your comments to the editors.
I recommend additional statistical review
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
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