Robot-assisted myomectomy: retrospective analysis of efficacy, safety, and reproductive outcomes

Background. Uterine fibroids are the most common benign tumors in women of reproductive age and one of the main indications for organ-sparing surgery. Robotic-assisted myomectomy represents a modern stage in the development of minimally invasive gynecologic surgery.

Aim. To evaluate the efficacy, safety and reproductive outcomes of robot-assisted myomectomy.

Materials and methods. A retrospective analysis included 393 patients with uterine fibroids who underwent robot-assisted myomectomy using the da Vinci Xi system between 2021 and 2025 at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov. Intraoperative parameters, complications, and reproductive outcomes were assessed.

Results. Multiple fibroids were present in 270 (68.7 %) patients, single in 123 (31.3 %). Mean fibroid size was 6–8 cm, maximum size was 14 cm. Conversion to laparotomy was required in 5 (1.27 %) cases. Mean operative time was 160 ± 40 min. Mean blood loss was 150 ± 50 mL. Mean hospitalization time was 4–5 days. Uterus was spared in all patients. Pregnancy occurred within 6–24 months in 40 (27 %) of 150 patients who planned to get pregnant. No uterine scar failure or uterine rupture was observed.

Conclusion. Robotic-assisted myomectomy is an effective and safe uterus-sparing method characterized by low complication rates, moderate blood loss, and favorable reproductive outcomes. The method is especially useful for multiple and large fibroids.

1. Elamin Elnour M.A.A., Yousif Mohamed A.M., Mahgoub Ahmed O.B. et al. Minimally invasive myomectomy: a systematic review of techniques, challenges, and fertility outcomes. Cureus 2025;17(6):e85246. DOI: 10.7759/cureus.85246

2. Nezhat C., Lavie O., Hsu S. et al. Robotic­assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy – a retrospective matched control study. Fertil Steril 2009;91(2):556–9. DOI: 10.1016/j.fertnstert.2007.11.092

3. Sinha R., Bana R., Peddappolla S.C. Feasibility and surgical outcomes of robotic myomectomy for large and multiple uterine fibroids – insights from a decade of experience at a single centre. J Robot Surg 2025;19(1):377. DOI: 10.1007/s11701­025­02538­4

4. Xie S., Wood T.C., Dasgupta P., Aydin A. Robot assisted laparoscopic surgery in gynaecology: an evolving assistive technology. Surg Innov 2024;31(3):324–30. DOI: 10.1177/15533506241238038

5. Gala R.B., Margulies R., Steinberg A. et al. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy. J Minim Invasive Gynecol 2014;21(3):353–61. DOI: 10.1016/j.jmig.2013.11.010

6. Adamyan L.V., Sibirskaya Ye.V., Obosyan L.B. et al. Robotics in reproductive medicine. Effektivnaya farmakoterapiya = Effective pharmacotherapy 2025;21(32):84–9. (In Russ.) DOI: 10.33978/2307­3586­2025­21­32­84­89

7. Kiss I., Svobodova P., Karasek L., Svoboda B. Current status on robotic assisted myomectomy. Mini­invasive Surg 2021;5:55. DOI: 10.20517/2574­1225.2021.70

8. Lawrie T.A., Liu H., Lu D. et al. Robot­assisted surgery in gynaecology. Cochrane Database Syst Rev 2019;4(4):CD011422. DOI: 10.1002/14651858.CD011422.pub2

9. Sheng Y., Hong Z., Wang J. et al. Efficacy and safety of robot­assisted laparoscopic myomectomy versus laparoscopic myomectomy: a systematic evaluation and meta­analysis. World J Surg Oncol 2023;21(1):230. DOI: 10.1186/s12957­023­03104­8

10. Wang T., Tang H., Xie Z., Deng S. Robotic­assisted vs. laparoscopic and abdominal myomectomy for treatment of uterine fibroids: a meta­analysis. Minim Invasive Ther Allied Technol 2018;27(5):249–64. DOI: 10.1080/13645706.2018.1442349

11. Chen W., Ma J., Yang Z. et al. Robotic­assisted laparoscopic versus abdominal and laparoscopic myomectomy: a systematic review and meta­analysis. Int J Gynaecol Obstet 2024;166(3):994–1005. DOI: 10.1002/ijgo.15485

12. Sinha R., Rupa B., Raina R. et al. Reproductive outcomes following robot­assisted laparoscopic myomectomy: 10 years’ experience. Cureus 2024;16(9):e70232. DOI: 10.7759/cureus.70232

13. Pitter M.C., Gargiulo A.R., Bonaventura L.M. et al. Pregnancy outcomes following robot­assisted myomectomy. Hum Reprod 2013;28(1):99–108. DOI: 10.1093/humrep/des365