Design: Case report illustrated with video.

Setting: Patient was placed in semi gynecological position, arms alongside the body and legs 80 grades abducted in adjustable leggings. Three robotic portals were placed on umbilical scar and both iliac fossae. One conventional portal was set in the right flank, for laparoscopic assistance.

Patients or Participants: A 40-year-old nulliparous patient reported irregular menstrual cycles. The patient was also undergoing treatment for infertility and had previous embryonic implantation without success. She came to myomectomy to improve implantation results.On physical examination, uterus was enlarged 3cm above pubic symphysis. MRI showed a 317cc uterus with multiples leiomyomas, the 4 main ones: intramural fibroid in the right lateral wall measuring 5.0cm; intramural with submucosal component in posterior wall measuring 3.2cm; fundal subserous fibroid measuring 3.5cm; and submucosal in anterior wall measuring 2.4cm.

Interventions: Patient was eligible for robotic-assisted myomectomy with the aid of intraoperative laparoscopic ultrasound to identify a bulky hidden intramural fibroid.

Measurements and Main Results: Surgery duration time was 2 hours. Patient was discharged on the next day, with no complaints. After 6 months, she underwent another embryo implantation, which was well succeeded. Pregnancy and cesarean delivery occurred without complications, with a healthy baby.

Conclusion: Robotic laparoscopic surgery has an advantage in multiple myomectomy surgeries, as it allows greater precision and ergonomic approach of different location fibroids, especially those on the posterior wall of the uterus. Moreover, use of intraoperative laparoscopic ultrasonography is an important and interesting surgical tool in the identification of remaining deep intramural fibroids. The correct identification of their topography diminishes myometrial damage during myomectomy.