Myomectomy has evolved from open laparotomy to laparoscopy, hysteroscopy, VNOTES and robotic myomectomy. The surgical approach in doing myomectomy depends on the type and location of the myoma and the surgeon\'s expertise. Minimally invasive surgery has been the preferred approach due to the benefit of shorter hospital stay, lesser postoperative pain, earlier recovery, minimal blood loss and the cosmetic appearance of the scar. The success of this procedure depends on the incision technique, enucleation, and blood loss prevention by using hemostatic techniques and suturing techniques. Performing myomectomy for a large uterine myoma is a laparoscopic challenge; however, with the use of Lee-Huang point (midpoint between umbilicus and xiphoid) as the primary insertion and camera port, one can easily navigate thru the abdominal cavity in case the uterus is huge obscuring the umbilical port. Laparoscopic Myomectomy can be safely and efficiently performed by experienced laparoscopic surgeons regardless of myoma size, number and location. Removal of large myoma specimen from the abdominal cavity through the laparoscope became a challenge after the use of power morcellator was abandoned. To overcome this problem, the large myoma is placed inside an Endo bag and its edges brought extracorporeally through the port site. The myoma is incised in a C-manner using a scalpel to reduce the size. Myoma can also be removed using in-bag power morcellation. Fertility preservation is the long-term aim of doing myomectomy instead of hysterectomy in the management of leiomyoma aside from alleviating symptoms of abnormal uterine bleeding, urinary frequency and abdominal pain.

BACKGROUND: Robotic surgery carries with it the potential to transform laparoscopic surgery by providing, for the 1st time, instruments with distal ends that mimic the intricate movements of the human hand while at the same time providing the surgeon with a high-definition, three-dimensional view of the operative field.
OBJECTIVE: To describe the clinical application of robotic surgery in benign gynecological conditions, as well as the components of the Da Vinci Si robotic system, analyzing the advantages and disadvantages of this type of surgical approach that it provides to the patient and in turn to the surgeon.
METHODS: Review of the literature in PubMed and UpToDate where the keywords of our review were searched. Inclusion criteria: Articles of cases or series containing the sections of the application of robotic surgery in gynecology and clinical results.
RESULTS: We found 50 scientific articles that included in their titles the key words of our review. 22 articles were discarded, 14 because they were inaccessible, 3 because they were published in bulletins without an impact factor and 5 because no information was obtained about the researcher\'s results, their volume, visibility and structure. A total of 28 articles were chosen for this review.
CONCLUSIONS: Robotic surgery has evolved to be a separate field, with enormous potential for future development. The results show until now that this technology is applicable and capable of offering an adequate treatment to selected patients.
BACKGROUND: La cirugía robótica conlleva el potencial de transformar la cirugía laparoscópica al proporcionar, por primera vez, instrumentos con extremos distales que imitan los intrincados movimientos de la mano humana, mientras que al mismo tiempo proporciona al cirujano una alta definición con visión tridimensional del campo operatorio.
OBJECTIVE: Describir la aplicación clínica de la cirugía robótica en padecimientos ginecológicos benignos, así como los componentes del sistema robótico Da Vinci Si, analizando las ventajas y desventajas que este tipo de abordaje quirúrgico brinda a la paciente y a su vez al cirujano.
UNASSIGNED: Revisión de la bibliografía en PubMed y UpToDate buscando las palabras clave de nuestra revisión. Criterios de inclusión: artículos de casos o series que contuvieran los apartados de la aplicación de la cirugía robótica en ginecología y resultados clínicos.
RESULTS: Se encontraron 50 artículos científicos que incluían en sus títulos las palabras clave de nuestra revisión. Se descartaron 22 artículos, 14 por ser inaccesibles, tres debido a que estaban publicados en boletines sin factor de impacto y cinco porque no se obtuvo información sobre los resultados del investigador, su volumen, visibilidad y estructura. Se escogieron para esta revisión 28 artículos.
CONCLUSIONS: La cirugía robótica ha evolucionado hasta ser un campo aparte, con un enorme potencial para su futuro desarrollo. Los resultados muestran que esta tecnología es aplicable y capaz de ofrecer un adecuado tratamiento a pacientes seleccionadas.

Uterine myomas are relative frequent in premenopausal women. The development of advanced minimally invasive surgical techniques proposed robotic-assisted myomectomy as an equally safe and effective treatment option.
PubMed, Scopus and Cochrane databases were systematically searched and 15 studies met the inclusion criteria for our meta-analysis.
Eight studies compared robotic technique to laparoscopic, while nine studies to open/abdominal technique. In total, 2,027 patients were included. In studies referring to the comparison between the robotic myomectomy and the open one, the robotic technique showed a significant inferiority in operative time [84.85 min per operation (95 % confidence intervals (CI) 60.41-109.29)], but superiority in estimated blood loss [92.78 ml/operation (95 % CI 47.26-138.29)], the need for transfusion [981 patients; odd ratio (OR) 0.20; 95 % CI 0.09-0.43], total complications (1101 patients; OR 0.31; 95 % CI 0.11-0.87) and in the length of hospital stay [1.84 days/patient (95 % CI 1.40-2.29)] over the open myomectomy.
Regarding the comparison between robotic assisted and laparoscopic technique, no significant difference was found between the two in comparison groups. Minimally invasive techniques have the advantage of less blood loss, less need for blood transfusion and less hospital stay. Additionally, long-term outcomes still need to be clarified including pain control, fertility and pregnancy rates postoperatively, as well as possible recurrence rates.

The primary surgical techniques used in myomectomy are open surgery, laparoscopic surgery, and, recently, robot-assisted (\"robotic\") surgery. The optimal surgical treatment of myomas is still a subject of debate because of the limitations of minimally invasive techniques and the disadvantages of laparotomy. In this article, the authors discuss the technique and the application of robotic myomectomy in the treatment of uterine fibroids.