Design: This is a literature review that focuses on preoperative, intraoperative, and postoperative considerations to decrease complications while managing sizable uterine fibroids. The review includes a case presentation.

Setting: University-associated community hospital

Patients or Participants: The study included a patient with a large fibroid causing mass effect symptoms and pelvic pain, who desired fertility preservation.

Interventions: Robotic-assisted laparoscopic myomectomy, intramyometrial vasopressin, and contain morcellation.

Measurements and Main Results: The patient was nulliparous and had a diagnosis of a 21 cm fundal uterine fibroid. She underwent a robotic-assisted laparoscopic myomectomy using a systematic approach that offered minimal blood loss and reduced the rate of complications associated with the procedure.

Conclusion: The minimally invasive management of large fibroids requires adequate pre-surgical planning and should be approached systematically. Every detail must be considered to increase the likelihood of positive fertility outcomes while avoiding adverse outcomes, such as injury to vital organs, hemorrhage, and hysterectomy. Robotic-assisted laparoscopic myomectomy is the safest and most effective approach to managing large fibroids, provided proper preoperative techniques, port placement, serosal incision, closure materials and techniques, and tissue removal are followed. It is essential in preserving fertility.