Objective: To review 20 years of experience of the removal of intra-abdominal intrauterine devices (IUDs) and to compare the surgical methods used. Methods: In a retrospective study, charts dating from between September 1, 1992, and August 31, 2012, were reviewed. Patients were eligible for inclusion when they had an IUD surgically removed by minilaparotomy or laparoscopy at a tertiary referral center in Izmir, Turkey. Results: Among the 36 eligible women, 18 (50%) had undergone laparoscopy and 18 (50%) had undergone minilaparotomy. Mean operation length was 55.3 +/- 6.3 minutes in the laparoscopy group and 29.1 +/- 4.2 minutes in the minilaparotomy group (P = 0.008). Conversion to full laparotomy was necessary in 4 (22%) women in the laparoscopy group and 1 (6%) in the minilaparotomy group (P = 0.02). Perioperative complications were observed in 5 (14%) women, with no difference in frequency between groups (P = 0.09). Total cost of medical/surgical procedures was US$436.4 +/- 35.4 for the laparoscopy group and $323.4 +/- 213 for the minilaparotomy group (P = 0.04). Conclusion: Minilaparotomy seems to be an important alternative to laparoscopy for the removal of intra-abdominal IUDs. This procedure should be an integral part of gynecologic surgical training. (C) 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.