Robotic Management of Uterine Fibroids with Fertility Preservation in Focus

Robotic-assisted myomectomy has emerged as an optimal surgical approach for managing uterine fibroids in women who wish to preserve fertility. The advanced visualization, instrument articulation, and precision offered by robotic platforms allow for meticulous dissection and reconstruction of the uterus, which is critical in cases involving large, multiple, or deeply intramural fibroids.

 

This technique proves particularly advantageous when addressing fibroids that distort the endometrial cavity—such as large intramural fibroids with submucosal components or purely submucosal fibroids—given their association with infertility, recurrent pregnancy loss, and obstetric complications. In such scenarios, a combined approach involving robotic myomectomy and operative hysteroscopy may be indicated to ensure complete fibroid removal while maintaining the anatomical and functional integrity of the endometrial cavity.

 

Several studies have confirmed the safety and efficacy of robotic myomectomy, demonstrating reduced blood loss, lower adhesion formation, and faster recovery compared to traditional open surgery, without compromising reproductive outcomes.

 

The Hellenic Society of Robotic Gynaecology Surgery (SHRGS) supports the implementation of robotic-assisted techniques in complex gynecologic surgery as a state-of-the-art tool that enhances surgical outcomes and supports fertility preservation.

 

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Key References & Guidelines

1.ACOG Practice Bulletin No. 228 (2021) – Management of Symptomatic Uterine Leiomyomas:

Emphasizes minimally invasive options, including robotic myomectomy, particularly in women desiring future fertility.

[American College of Obstetricians and Gynecologists]

2.ESGE/ESHRE/ WES Consensus on the classification of uterine fibroids and reproductive impact (2021)

– Discusses the surgical approach for fibroids with submucosal or intramural extension.

[European Society for Gynaecological Endoscopy (ESGE)]

3.Nezhat C. et al. (2016). Robotic-assisted laparoscopic myomectomy versus standard laparoscopic myomectomy: a comparison of short-term surgical outcomes.

Journal of Minimally Invasive Gynecology, 23(6): 928–934.

doi:10.1016/j.jmig.2016.06.008

4.Pundir J. et al. (2013). Robotic versus laparoscopic myomectomy: a systematic review and meta-analysis.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 171(1): 1–9.

doi:10.1016/j.ejogrb.2013.07.017

5.Mettler L. et al. (2020). The role of hysteroscopy in the combined approach for complex fibroid cases.

Facts Views Vis Obgyn, 12(1): 21–29.