Introduction/Background Aggressive angiomyxoma is an infrequent mesenchymal tumor, primarily arising in the soft tissue. Either diagnosis and treatment are challenging and proper surgical planification is crucial to remove the tumor completely. We present a surgical video about complete excision of massive vulvar angiomyxoma.

Methodology A 43-year-old patient was suspected of vulvar angiomyxoma due to vulvar asymmetry. MRI and 3D reconstruction were performed for surgical planification and high tumor of 195x159 mm (wide x length) was observed from left ischio-anal fossa to left para-vesical space. Patient underwent a combination of robotic (Da Vincy Xi System®) and vaginal surgery.

Results The patient was discharged after 48h from surgery. After 30 days from surgery, no complications were recorded. Pathological results confirmed aggressive vulvar angiomyxoma.

Conclusion Optimal surgery planification is mandatory for infrequent tumors such as vulvar angiomyxoma. 3D reconstruction, even augmented reality, are excellent tools for guiding surgery. Combination of abdominal approach by robotics and conventional vaginal approach, allows to complete challenging surgeries as high volume angiomyxoma.