<h3>Study Objective</h3> To examine trends in surgical management of patients with uterine leiomyoma and explore disparities in surgical approach in a modern cohort. <h3>Design</h3> Retrospective cohort study of data abstracted from American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. <h3>Setting</h3> NSQIP-participating hospitals across the United States. <h3>Patients or Participants</h3> 52,909 women who underwent hysterectomy and 15,485 who underwent myomectomy between 2015 and 2019. Patients were excluded if they had a gynecologic malignancy, emergent surgery, or both hysterectomy and myomectomy in the study timeframe. Cases were identified by Current Procedural Terminology code. <h3>Interventions</h3> Hysterectomy or myomectomy for leiomyoma performed by any abdominal or minimally invasive approach, including laparoscopic, vaginal, or robotic assisted. <h3>Measurements and Main Results</h3> Regression and Cochran-Armitage Trend Test were conducted. The overall number of surgeries for leiomyoma (hysterectomy and myomectomy) rose from 10,896 in 2015 to 15,716 in 2019 (44.24% increase). The number of hysterectomies increased from 8,624 in 2015 to 11,846 in 2019 (37.36%), while myomectomies increased from 2,272 in 2015 to 3,870 in 2019 (70.33%). The proportion of patients who underwent myomectomy significantly increased (20.85% to 24.62%, p-value <0.0001), whereas hysterectomy significantly decreased (79.15% to 75.38%, p-value <0.0001). The number of non-Hispanic Black women receiving myomectomy rose from 913 in 2015 to 1,540 in 2019 (68.67%). The number of Asian women receiving myomectomy rose from 191 in 2015 to 372 in 2019 (94.76%). <h3>Conclusion</h3> Increasing rate of surgical treatment for leiomyoma was seen over the study period. A shift towards myomectomy comprising a greater proportion of surgeries performed was identified. The greatest increase in number of myomectomy performance was for Non-Hispanic Black and Asian women. These trends may represent improved access to surgical treatment of leiomyoma, resulting from the growth of Minimally Invasive Gynecologic Surgery as a sub-specialty. Additionally, these findings may suggest a positive response to notable advocacy for equitable healthcare for all patients.