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To compare the long-term outcome of laparoscopic myomectomy with MR-guided focused ultrasound (MRgFUS) for symptomatic uterine fibroids. A cohort study, from January 2012 to January 2017. Single tertiary care center. All patients with symptomatic uterine fibroids treated operatively with laparoscopic myomectomy or treated conservatively with MR-guided focused ultrasound. A telephone interview was performed to assess further interventions and sustained fibroid associated symptoms using the Uterine Fibroid Symptom and Quality of Life symptom severity score (UFS-QOL-SSS). One-hundred fifty-four women met the inclusion criteria. Complete follow-up was achieved for 64 women underwent laparoscopic myomectomy and 68 were treated by MRgFUS. Follow up time was similar for both groups (median, IQR: 31 month, (17-51) vs 36 month (24 - 41); P=0.95, respectively). The rate of additional interventions was 5 (7.8%) and 9 (13.2%), respectively (p=0.312). Similarly, the uterine fibroid symptom-quality of life-symptom severity score (QOL-SSS) questionnaire at follow up interview revealed comparable score 17(12-21) vs 17 (13-22) for laparoscopic myomectomy and MRgFUS, respectively (p=0.439). Analyzing each of the symptoms separately (bleeding, changes in menstruation, abdominal pain, bladder activity, nocturia, fatigue), did not change these findings. Long term outcome and surgical intervention following MRgFUS treatment for uterine fibroids seems comparable with that laparoscopic myomectomy. Further larger randomized trials are needed to confirm these findings. [ABSTRACT FROM AUTHOR]