Clinical Efficacy of Robot-Assisted Laparoscopic Myomectomy versus Conventional Laparoscopic Myomectomy for Large Intramural Fibroids

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 927–938

DOI: 10.46882/2026/IJOG/000558

Original Research Article

Title: Clinical Efficacy of Robot-Assisted Laparoscopic Myomectomy versus Conventional Laparoscopic Myomectomy for Large Intramural Fibroids

Names of Authors: Elena R. Vasilyeva¹, Hans-Dieter Schmidt²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Sechenov First Moscow State Medical University, Moscow, Russia
² Division of Gynecological Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany

Abstract:
Laparoscopic excision of large intramural leiomyomas can be technically restricted by instrument triangulation barriers and complex multi-layered uterine reconstruction requirements. This prospective multi-center randomized trial compared the perioperative surgical outcomes, multi-layer suturing quality, and 1-year scar integrity of Robot-Assisted Laparoscopic Myomectomy (RALM) against Conventional Laparoscopic Myomectomy (CLM). A cohort of 160 premenopausal women presenting with 1 to 3 symptomatic intramural fibroids (dominant lesion diameter 7 to 10 cm) was randomized into two equal groups (n = 80 per group). The primary endpoints evaluated were total suturing time for myometrial defects and total intraoperative blood loss. The mean myometrial suturing duration was significantly shorter in the RALM group compared to the CLM cohort (14.5 ± 3.2 minutes vs. 24.8 ± 5.6 minutes, p < 0.001), facilitated by articulated robotic instrumentation. Consequently, the mean total intraoperative blood loss was significantly lower in the robotic arm (112.4 ± 35.8 mL vs. 185.6 ± 52.4 mL, p < 0.001). Postoperative visual analog scale pain scores at 24 hours were lower in the RALM cohort (p = 0.012). Transvaginal ultrasound evaluation at month 12 revealed zero cases of sub-optimal uterine wall healing or persistent hematomas in either arm. Robot-assisted laparoscopic myomectomy for large intramural fibroids significantly lowers operative blood loss and accelerates myometrial reconstruction timelines compared to conventional laparoscopy due to enhanced rotational dexterity.

Keywords: Robotic Myomectomy; Laparoscopy; Uterine Fibroids; Intramural Leiomyoma; Myometrial Suturing; Operative Blood Loss.

Manuscript Timeline: Received: June 15, 2026; Revised: August 10, 2026; Accepted: September 02, 2026; Published: September 05, 2026.

Citation: Vasilyeva ER, Schmidt HD. Clinical Efficacy of Robot-Assisted Laparoscopic Myomectomy versus Conventional Laparoscopic Myomectomy for Large Intramural Fibroids. International Journal of Obstetrics and Gynecology. 2026; 14(9): 927–938.

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