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In this case, pre-operative planning is the key component to all three groups' thought process where the MRI findings are suggestive of an atypical leiomyoma. MIGS and GYN-Onc both recommend an endometrial biopsy to evaluate for leiomyosarcoma. Despite this being a very large transmural fibroid involving the endometrial cavity with suspicious MRI findings, all specialties agree that a laparoscopic approach was appropriate, with MIGS and REI focusing on the inevitability of needing to repair the endometrial defect and avoiding intrauterine adhesions. Further, in view of the patient's advanced age, both MIGS and REI recommend IVF and embryo banking shortly post-operatively now that her ovaries should be accessible and given that her uterus needs time to heal.