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From various sonomorphological measurement parameters, the residual myometrial thickness (RMT) is crucial for predicting an obstetric complication in a subsequent pregnancy. A low RMT can be improved by surgical correction. The purpose of this paper is to present our technique for robotic-assisted laparoscopic niche repair (RALNR), to sonomorphologically characterize the niches pre- and postoperatively and to surveil subsequent symptoms and pregnancies. A cohort study of 35 patients with a niche and the wish to conceive, who had undergone RALNR between 05\/2019 and 09\/2023 at the university hospital of Zurich, was conducted. Sonomorphological parameters before and 6\u00a0weeks after surgery, as well as surgical, clinical and obstetrical outcomes were assessed. The mean widths and depths of the niche were significantly reduced (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), width from 10.0\u2009\u00b1\u20093.5\u00a0mm preoperatively to 2.6\u2009\u00b1\u20093.4\u00a0mm postoperatively, and depths from 9.1\u2009\u00b1\u20093.7\u00a0mm preoperatively to 1.8\u2009\u00b1\u20092.6\u00a0mm postoperatively. RMT was significantly improved after RALNR (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) with mean 1.5\u2009\u00b1\u20091.5\u00a0mm preoperatively compared to 8.3\u2009\u00b1\u20092.9\u00a0mm postoperatively. The pregnancy rate was 13 of 18 (77%), and 7 re-cesarean sections were performed at term. Following surgery, RMT is improved, and subsequent pregnancy rates are high. Larger prospective studies with different long-term obstetric outcomes are needed to determine the clinical significance of RALNR in subsequent pregnancies. This effort advances the field`s state of the art by demonstrating a successful technique for RALNR and its clinical feasibility in a symptomatic cohort.\n                  <\/jats:p>","DOI":"10.1007\/s11701-025-02394-2","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T02:37:59Z","timestamp":1748486279000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Robotic-assisted laparoscopic niche repair (RALNR): technique development and pregnancy-associated outcomes"],"prefix":"10.1007","volume":"19","author":[{"given":"Anne","family":"Muendane","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azadeh","family":"Babaei Bidhendi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Imesch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabell","family":"Witzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia","family":"Betschart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"key":"2394_CR1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-005671","author":"AP Betran","year":"2021","unstructured":"Betran AP, Ye J, Moller AB et al (2021) Trends and projections of Caesarean section rates: global and regional estimates. 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