Purpose of Review <p>Laparoscopic and robot-assisted myomectomy has an evolving role in gynecologic surgery and is associated with lower complication rates and improved patient experience. The purpose of this review is to focus on preparation and surgical techniques to optimize patient outcomes.</p> Recent Findings <p>Magnetic resonance imaging (MRI) is the preferred imaging modality for surgical planning of laparoscopic myomectomy, and key advancements such as three-dimensional (3D) modeling may further aid in precise surgical planning. Correcting pre-operative anemia via iron supplementation and/or medical management of abnormal uterine bleeding (AUB) is crucial to reduce risk of blood transfusion, although new advancements in use of tranexamic acid (TXA), gonadotropin releasing hormone (GnRH) antagonists, and uterine artery embolization (UAE) in selected cases are promising. Effective medications and techniques for managing intraoperative blood loss include vasopressin, misoprostol, and multilayered uterine closure with barbed suture. Morcellation of large fibroid specimens within a contained system are a safe alternative to laparotomy in low-risk patients.</p> Summary <p>Laparoscopic and robot-assisted myomectomy are now standard for surgical management of most symptomatic fibroids, providing significant advantages over open surgery. Preoperative optimization and evidence-based surgical techniques improve outcomes and safety in minimally invasive myomectomy. Continued advancements in technology and methods are essential for further enhancing laparoscopic myomectomy procedures.</p>