ABSTRACT
Laparoscopic myomectomy, with or without robotic assistance, is the minimally invasive approach of choice for the fertility-sparing management of most symptomatic intramural and subserosal fibroids. Patients should be properly selected with special attention to number, type, size, and site of fibroids and appropriately counseled and consented preoperatively. This chapter discusses preoperative management, including gonadotropin-releasing hormone agonist therapy. Instrumentation and surgical steps are discussed in detail. Particular attention is paid to the use of dilute vasopressin solution, chromopertubation, and techniques of safe tissue extraction including morcellation. Laparoscopic-assisted and robotic-assisted myomectomy and postoperative management are also discussed. Finally, intraoperative ultrasound guidance is briefly discussed.
