Aim. To evaluate safety of robot-assisted access compared to laparoscopic, abdominal, and vaginal accesses during sacrocolpopexy for pelvic organ prolapse.

Materials and methods. Randomized and non-randomized trials involving women suffering from pelvic organ prolapse were included in the analysis. A search for studies published prior to January of 2026 was performed in the PubMed, Medline and Cochrane Library databases. The following key words were used: robotic, sacrocolpopexy, and pelvic organ prolapse. Articles describing other types of interventions and articles without comparative analysis were not included in this review.

Results. In total, 36 studies were selected for the systematic review. The rate of postoperative complications in robot-assisted sacrocolpopexy was comparable to the rates in surgeries without the use of robotic devices. The volume of intraoperative blood loss did not differ from the volume during standard intervention through laparoscopic or abdominal access, but in vaginal access blood loss volume was significantly higher. Additionally, conversion rate for robot-assisted access was lower than for laparoscopic access. However, laparoscopic and vaginal accesses were characterized by shorter operative time compared to robot-assisted sacrocolpopexy. In-hospital time was shorter for robot-assisted access but compared to vaginal surgeries, no significant differences were observed.

Conclusion. Robot-assisted sacrocolpopexy might be associated with the following benefits: lower blood loss compared to vaginal access and shorter hospitalization time compared to laparoscopic sacrocolpopexy. However, more accurate and objective confirmation of safety of robot-assisted sacrocolpopexy requires further high-quality prospective randomized trials.

Introduction. Sacrocolpopexy (SCP) is a well-established technique that over the past decades has become the “gold standard” for the correction of apical pelvic organ prolapse (POP) due to its high efficacy. The widespread adoption of robotic surgery allowed to make this labor-intensive intervention more ergonomic.

Aim. To evaluate long-term efficacy of robot-assisted SCP in patients with POP.

Materials and methods. The single-center cohort prospective study included 309 patients with isolated or combined stage III–IV apical POP according to the Pelvic Organ Prolapse Quantification system (POP-Q). All patients underwent robot-assisted POP repair at the V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology between 2013 and 2024. Subjective outcomes were assessed using the internationally validated questionnaires: Pelvic Organ Prolapse Distress Inventory-20, Pelvic Floor Impact Questionnaire-7, and Pelvic Organ Prolapse Incontinence Sexual Questionnaire-12.

Results. Median postoperative follow-up period for patients was 74.6 (44.5–110.2) months. The most common phenotype of recurrent disease was anterior vaginal wall prolapse, accounting for 5.8 % (n = 18) of observations. Recurrence of the sensation of a foreign body in the vagina occurred in 3.9 % (n = 12). Despite this, the reoperation rate was 1.6 % (n = 5). Intraoperative complications occurred in 2.3 % (n = 7) of patients, and there were no cases of conversion. Vaginal erosions were observed in 0.3 % (n = 3) of operated women.

Conclusion. The obtained data reflect the long-term efficacy of robot-assisted SCP, highlighting its viability as a surgical treatment for apical POP. It is most relevant to consider this intervention for patients after previous reconstructive plastic surgery or hysterectomy. The target patients for the robot-assisted approach are women with complex surgical history, severe somatic diseases, and obesity.

Introduction. Unilateral pectineal suspension (UPS) is a novel method for mesh-free apical prolapse correction. Short-term follow-up results 6 months after isolated UPS have been very encouraging, resulting in excellent apex stability and high patient satisfaction in a cohort of 47 patients with mostly advanced prolapse.

Aim. To evaluate the apex stability and the frequency of residual defects requiring secondary surgery 24 months after isolated UPS.

Materials and methods. In order to assess the long-term outcome after isolated UPS, all 47 patients from the original patient cohort treated with isolated UPS were invited for a scheduled follow-up examination after a minimum follow-up period of two years to determine whether the result of the primary surgery remained stable. We analyzed the outcome with regard to apex stability, residual defects, and procedure-related morbidity.

Results. UPS as a stand-alone procedure showed high stability at the apex. Throughout the two-year follow-up period, only 2 (4.3 %) patients required secondary surgery for apical recurrence. Increasing age correlated significantly with apical recurrence. Six (13.0 %) patients became symptomatic in the anterior and/or the posterior compartment while the apex remained stable. With increasing age, the probability of secondary surgery also appeared to rise, however, this was not statistically significant. There was no method-related morbidity.

Conclusion. Two-year follow-up after isolated UPS shows stable results at the apex. A combined approach may be valuable to reduce the potential necessity of secondary surgery in the anterior/posterior compartment.

Background. Robot-assisted surgery allows to overcome technical limitations of standard laparoscopy due to 3D visualization, elimination of physiological tremor, and use of instruments with seven movement degrees of freedom.

Aim. To evaluate perioperative and early oncological results of robot-assisted interventions in a mixed cohort of female patients with oncological diseases of the reproductive organs.

Materials and methods. A retrospective analysis of 310 patients who underwent surgery at the Division of Gynecology of the N.N. Blokhin National Medical Research Center of Oncology between June 2021 and December of 2025 with the use of the da Vinci surgical systems. The volume of surgical interventions, perioperative parameters, frequency of conversions, recurrence-free and overall survival were evaluated. The analysis was performed considering nosology of the disease: uterine cancer, cervical cancer, ovarian cancer.

Results. In patients with uterine cancer (n = 250), hysterectomy and extirpation of the fallopian tubes, in some cases in combination with resection of the ovaries, was performed. Access conversion was necessary in 1 case. Mean operative time was 120 (70–260) min, mean blood loss volume was 70 (10–1800) mL. Mean follow-up was 14.7 (1.0–55.4) months. Recurrence was detected in 2 (0.8 %) of 250 patients, both patients died due to disease progression. Recurrence-free and overall survival were 99.2 %. In patients with cervical cancer (n = 53), extirpation of the uterus, radical trachelectomy, pelvic lymph node dissection, radical and aborted hysterectomy were performed. Mean operative time was 210 (120–210) min, mean blood loss volume was 100 (50–400) mL. Conversion was necessary in 1 case. Mean follow-up was 13.6 (1.0–39.6) months. Recurrence was detected in 2 (3.8 %) patients. Recurrence-free survival was 96.2 %, overall survival was 98.1 %. In patients with ovarian tumors (n = 7), extirpation of the uterus with appendages or organ-saving treatment in the form of adnexectomy, as well as resection of the greater omentum were performed. Mean operative time was 90 (80–120) min, mean intraoperative blood loss volume was 90 (80–120) mL. No conversions, recurrences and deaths were reported during the mean follow-up of 8 (1.0–50.1) months.

Conclusion. The most reliable conclusion can be made for patients with uterine cancer: low frequency of conversions (0.4 %) and recurrences (0.8 %) confirms safety of the access including in 80 % of patients with obesity. For cervical cancer, the results align with the LACC and SUCCOR trial data, but robot-assisted interventions are allowed only after strict selection of patients of low risk. For early ovarian tumors, robot-assisted access is acceptable for staging, but it is not indicated for advanced disease. Data interpretation for these cases is limited, which dictates the necessity of further prospective studies.

Background. Uterine cancer is one of the most common oncological diseases in women. Among women between the ages of 60 and 74 years, it’s the 2nd most common cancer. This underlies the importance of studies aimed at improvement of treatment of this disease. Implementation of robotic technologies is seen as a promising method for improvement of surgical results of uterine cancer treatment in accordance with all oncological principles.

Aim. To analyze clinical results of robot-assisted uterine extirpation in patients with stage I endometrioid uterine cancer.

Materials and methods. Between 2023 and 2025, at the Division of Oncological Surgery of Pelvic Organs of the A.S. Loginov Moscow Clinical Research Center of the Moscow Healthcare Department, 450 robot-assisted uterine extirpations due to stage Ia–Ib endometrioid uterine cancer were performed. Mean age of the patients was 60.2 [34–86] years. Mean BMI was 37.5 [18.5–56.4] kg/m2, in 20 % this parameter was higher than 40 kg/m2, maximum value was 56.4 kg/m2. Practically all patients had history of somatic diseases.

Results. Standard extirpation of the uterus with appendages was performed in 369 (82 %) cases, extirpation of the uterus with fallopian tubes in 18 (4 %) cases (in patients younger than 45 years), extirpation of the uterus and pelvic lymph node dissection in 63 (14 %) cases. Total operative time was 99.9 [55–210] min, duration of the Xi da Vinci robotic system docking varied between 5 and 10 min. Mean blood loss volume was 95 [50–150] mL. In 1 patient with burdened oncological and surgical history, conversion was performed due to extensive adhesive process in the abdominal cavity. No significant complications per the Сlavien–Dindo classification were reported.

Conclusion. The results demonstrate safety of robot-assisted surgery per the main parameters of the perioperative period: operative time, blood loss volume, risk of blood transfusion, conversion and complication rates, hospitalization time. Minimal invasiveness, high accuracy and ergonomics in combination with oncological radicalness make robot-assisted interventions a method of choice for surgical treatment of stage I endometrioid uterine cancer if technical equipment and experienced surgical team are available.

Aim. To objectify the significance of practical experience in retroperitoneal lumbar lymphadenectomy, an attempt was made to analyze, which consisted in studying the learning curve, which included the dynamics of specific indicators that change as experience accumulates.

Materials and methods. A cohort retrospective study was conducted, including 91 patients with verified uterine body cancer of stages I–III, who were treated in the oncogynecology department № 70 of the S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center from 2023 to 2025.

Results. The plateau of the time of laparoscopic operations was reached from the 47th operation (before 265 ± 40 min, after 170 ± 23 min). However, the number of removed lymph nodes reached a consistently high value by the 20th operation (before 20 ± 5, after 28 ± 4). In the group of robot-assisted retroperitoneal lumbar lymphadenectomy from the beginning of the mastering of the technique, the operation time was reduced by 1.5 times to the 18th operation (the median time of operations from the beginning of the development of the technique to the 18th operation is 272 ± 43 min, after 180 ± 27 min). The tendency to reduce the time of surgical intervention became more obvious after the rejection of the 4th robotic “arm” due to greater convenience in the surgical field. Similarly, the plateau of the number of removed lymph nodes was reached after the 18th operation (before 19 ± 5, after 26 ± 3).

Conclusion. The complexity of pelvic and paraaortic lymphadenectomy leads to the search for optimal surgical technologies, which in turn can be objectively assessed only after overcoming the learning curve.

Introduction. The use of anti-adhesion barriers in intestinal anastomoses, regardless of surgical approach, remains controversial in terms of their safety.

Aim. To evaluate the safety of a hyaluronic acid-containing anti-adhesion gel in intestinal anastomosis during robot-assisted procedures for deep infiltrating endometriosis.

Materials and methods. A single-center, prospective, controlled trial was conducted in 76 patients with deep infiltrating endometriosis and bowel lesions. Randomization to the control and study intervention groups was based on the use of a hyaluronic acid-containing gel anti-adhesion barrier (Antiadhesin). The evaluation protocol included careful monitoring of clinical parameters (the incidence of postoperative complications: anastomotic leakage, peritonitis, abdominal abscesses, sepsis), as well as laboratory markers of inflammation in the postoperative period.

Results. The use of a hyaluronic acid-containing anti-adhesion barrier was not associated with an increased incidence of postoperative complications, including anastomotic leakage (p > 0.05 for all comparisons).

Conclusion. An anti-adhesion barrier composed of carboxymethylcellulose and hyaluronic acid demonstrates a favorable safety profile when used in intestinal anastomoses. The obtained results support the need for further large-scale studies to confirm the efficacy and safety of this barrier in various types of laparoscopic procedures.

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.

Background. Vaginal natural orifice transluminal endoscopic surgery (VNOTES) is an innovative technique of endoscopic surgery in which abdominal organs are accessed through the vagina. The relevance of studying robot-assisted vNOTES hysterectomy is driven by the need for an objective assessment of its advantages and the potential for its introduction into widespread clinical practice, as well as identification of potential areas for more indications.

Aim. To analyze efficacy and safety of robot-assisted hysterectomy using transvaginal endoscopic access.

Materials and methods. The study included 5 patients with obesity and absence of severe prolapse of the pelvic organs. The following data were retrospectively assessed: indications for surgery, intraoperative characteristics, blood loss volume, postoperative pain intensity, requirement for analgesics, complication rate.

Results. Mean age of the patients was 51.6 ± 4.98 [46.5; 56.0] years. Mean operative time was 106.8 ± 14.25 [95.0; 122.0] minutes. No conversions to laparotomy or conventional laparoscopy were required. Blood loss volume amounted to 104.0 ± 46.15 [67.5; 150.0] mL. The VAS score assessed at 6 and 12 hours postoperatively was 5.0 ± 0.71 [4.5; 5.5] and 3.2 ± 0.45 [3.0; 3.5], respectively. The postoperative hospital stay was 5 days. In this case series, no complications were identified either during the surgical procedure or during the 6-month postoperative follow-up period.

Conclusion. Robotic vNOTES hysterectomy opens new horizons in the field of minimally invasive gynecology and warrants further implementation into clinical practice.

Background. Natural orifice specimen extraction (NOSE) is an innovative technique of endoscopic surgery in which with specimen extraction through the natural orifice. The relevance of studying robot-assisted colorectal NOSE resection is driven by the need for an objective assessment of its advantages and safety.

Aim. To evaluate the safety and short-term clinical outcomes of robotic-assisted bowel resections with specimen extraction through the anal canal in patients with colorectal endometriosis.

Materials and methods. A retrospective cross-sectional study was conducted based on the analysis of data from 66 patients with confirmed deep infiltrative colorectal endometriosis. All patients underwent robot-assisted colorectal NOSE resection.

Results. The mean age of the patients was 35.4 years (range 23 to 49 years). The mean body mass index was 23.36 kg/m2 (range 16.65 to 33.12 kg/m2). The mean operative time for robotic-assisted colorectal resection using the NOSE technique was 144.6 ± 50.1 min. The mean intraoperative blood loss was 124.6 ± 90.8 mL. On postoperative day 2, 13 patients presented with a body temperature elevation up to 38°C.

Conclusion. Robotic-assisted laparoscopy combined with the NOSE technique is a technically feasible, safe, and effective approach in the comprehensive surgical management of colorectal endometriosis. The technique offers several advantages: reduction in the consumption of disposable instruments, absence of a laparotomic incision, accelerated postoperative rehabilitation.

Background. Development of robot-assisted technologies allowed to significantly increase accuracy of surgical interventions. However, with all of the benefits of the da Vinci robotic surgical system, assessment of endometriosis lesion growth into the surrounding tissues is complicated even during robot-assisted treatment. This problem can be solved by using fluorescent navigation with indocyanine green.

Aim. To evaluate the results of surgical treatment of patients with severe forms of genital endometriosis using the da Vinci robotic surgical system and fluorescence imaging of the surgical field.

Materials and methods. Data of 39 patients who underwent surgery at the N.I. Pirogov National Medical and Surgical Center, Ministry of Health of Russia, between 2023 and 2025 were analyzed. Operative and hospitalization times, blood loss volume, intra- and postoperative complication rates, number of identified and histologically confirmed “hidden” endometriosis lesions invisible during surgery in standard white light, duration of adequate staining of endometriosis-affected tissues during fluorescent visualization, clinical disease course in the postoperative period were analyzed.

Results. Mean blood loss volume was 179.5 ± 116.6 mL, mean operative time was 238 ± 147.3 min. In all patients, 15–30 min after intravenous infusion of indocyanine green, endometriosis lesions were stained green with sharp boundaries. Adequate lesion staining persisted for 49.7 ± 16.0 min. In 29 (74.4 %) cases, fluorescent visualization allowed to identify residual endometriosis lesions invisible in white light; they were sent for histological examination (60 samples) which confirmed endometrioid nature of 51 (85 %) samples. Postoperative complication (intraabdominal hemorrhage from the area of trocar port) was observed in 1 (2.6 %) patient on day 2 after surgery. Mean hospitalization time was 7.1 ± 2.8 days. At the time of examination 12 months after treatment, the patients reported disappearance of pelvic pain, dysmenorrhea, hyperpolymenorrhea, and dyspareunia. No signs of recurrent external genital endometriosis were found.

Conclusion. High diagnostic value of intraoperative visualization with indocyanine green allowing for timely correction of surgery and minimization of the risk of incomplete endometriosis lesion excision was demonstrated.