Study Objective Compares postoperative clinical outcomes and cost of Abdominal (AM) and Robotic Laparoscopic (RLM) Myomectomy. Design Retrospective single-center study. Setting Surgeries performed by the author at Emory Saint Joseph's Hospital. Patients or Participants All Myomectomies performed during the study period were symptomatic ultrasound confirmed Leiomyoma patients. 419 cases of RLM and 65 cases of AM were identified between January 1st, 2009 and December 31st, 2017. Interventions AM is considered more involved operation: associated with higher morbidity, blood loss and adhesion formation rates. RLM provides surgeons with improved optics, three dimensional view, and increased dexterity and precision. This facilitates excision of tumors and repair of uterine incisions. Personal and clinical data were collected from EMR. All patients were interviewed and willing patients were administered post-operative questionnaire (297/484 completed, 61.4%). Measurements and Main Results Study compared total operative time, total estimated blood loss (EBL), length of hospital stay, post- operative outcomes including self care and cost. AM had significantly longer hospital stay (2.3 days vs. 1.4 days) and significantly higher EBL (178.5 mL vs. 105.9 mL) than RLM. Post-operative pain level and days of analgesic use lower in RLM than in AM, but not significant. RLM had significantly fewer number of weeks to return to work (4.2 vs. 5.7 weeks), significantly fewer number weeks until resuming sexual activity (7.1 vs. 11.2 weeks) and significantly fewer days until independent self care (7.7 vs. 10.4 days) than AM. Conclusion RLM has advantages clinically and technically over AM. In some cases, AM are the only practical option technically to perform myomectomy. Dealing with very large fibroid tumors, extensive pelvic and/or abdominal endometriosis, severe pelvic/abdominal bowel adhesions and very short stature patients, use of laparoscopy increases risk of injury to vital pelvic and abdominal organs. Cost is higher in AM than RLM but not significant.