Robot-Assisted Laparoscopic Versus Open Adenomyomectomy: Comparative Surgical and Reproductive Outcomes

Background/Objectives: This study aimed to compare the surgical and reproductive outcomes between open and robot-assisted laparoscopic adenomyomectomy in women with symptomatic adenomyosis. Methods: This was a prospective cohort study conducted between 29 April 2017 and 21 December 2023 at a university-affiliated tertiary hospital in Seoul, Republic of Korea. The study included patients who underwent uterus-sparing adenomyomectomy for symptomatic adenomyosis. Eligible participants were premenopausal women seeking fertility preservation or symptomatic relief when medical therapy was ineffective and hysterectomy was not desired. Interventions consisted of open adenomyomectomy and robot-assisted laparoscopic adenomyomectomy. Results: A total of 76 patients were included: 21 underwent open adenomyomectomy (OA) and 55 received robot-assisted laparoscopic surgery (RLA). Patients in the OA group had larger adenomyotic lesions (7.1 ± 2.7 vs. 5.4 ± 1.7 cm, p = 0.001) and greater estimated blood loss (400 mL [200-700] vs. 300 mL [200-400], p = 0.05). Hospitalization was significantly shorter in the RLA group (β = -2.1 days, 95% CI -2.7 to -1.6, p < 0.001) after adjustment for lesion size. Overall delivery rates were comparable; however, the robotic cohort demonstrated fewer intraoperative endometrial exposures (10.0% vs. 55.6%, p = 0.033) and more favorable obstetric outcomes, with most deliveries reaching full term without postpartum complications. Conclusions: Compared with open surgery, robot-assisted laparoscopic adenomyomectomy was associated with reduced blood loss, shorter recovery, and favorable reproductive outcomes, supporting its value as a uterus-sparing treatment.