Reviewer’s report
Title: 
Blood Loss from Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: A
Randomized Controlled Trial
Version: 
2 
Date: 
20 Feb 2020
Reviewer's report:
This manuscript concerns a very interesting topic not adequately addressed in the literature.
The authors mistakenly cite a study, ref. 6, which states that longitudinal incisions are associated with weaker
scars and higher incidence of uterine rupture in subsequent pregnancies compared to transverse uterine
incisions. But this concerns cesarean sections and not myomectomies, which are a very different thing, as we
are talking about completely different anatomy. The anatomy of the lower uterine segment is totally different
from the myometrium distended by myoma. I therefore ask to remove this reference. The authors should clarify
why they implement the transverse elliptical uterine incision. When is the biological rationale? 
What is false capsules? In literature there is a pseudocapsule (many citations), but there is no false capsule. The
authors need to clarify.
The authors state: Tissue planes are bluntly and / or sharply dissected and the myoma is resected with the
overlying ellipse of myometrium and false capsules ......
Then they remove, in addition to the fibroid, also part of the uterine tissue attached to the fibroid, or the
pseudocapsule.
The literature is full of data about the importance of preserving the pseudocapsule during myomectomy, for
the ability to regenerate the tissue and to heal optimally. Please clarify.
What baffles me that this manuscript must move from solid biological bases to translate to surgery.
Instead I have the impression that the authors think more of the scientific methodology of data collection rather
than the actual biological surgical veracity of their research.
So the whole search falls apart and the results are fallacious.
Therefore we ask to review the M&M in depth.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional statistical
review?
If an additional statistical review is recommended, please specify what aspects require further assessment in
your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
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