{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T05:39:53Z","timestamp":1793425193289,"version":"4.5.0"},"reference-count":30,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Korea Research Foundation for Gynecologic Cancer","award":["not applicable"],"award-info":[{"award-number":["not applicable"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 \u00b1 2.7 vs. 5.4 \u00b1 1.7 cm, p = 0.001) and greater estimated blood loss (400 mL [200\u2013700] vs. 300 mL [200\u2013400], p = 0.05). Hospitalization was significantly shorter in the RLA group (\u03b2 = \u22122.1 days, 95% CI \u22122.7 to \u22121.6, p &lt; 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.<\/jats:p>","DOI":"10.3390\/jcm15062120","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T17:04:24Z","timestamp":1773162264000},"page":"2120","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Robot-Assisted Laparoscopic Versus Open Adenomyomectomy: Comparative Surgical and Reproductive Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9002-2945","authenticated-orcid":false,"given":"Jung Hyun","family":"Park","sequence":"first","affiliation":[{"name":"Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Soule St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2167-7243","authenticated-orcid":false,"given":"Jae-Yen","family":"Song","sequence":"additional","affiliation":[{"name":"Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Soule St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mee-Ran","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Soule St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8186-6230","authenticated-orcid":false,"given":"Youn-Jee","family":"Chung","sequence":"additional","affiliation":[{"name":"Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Soule St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/0002-9378(72)90781-8","article-title":"The elusive adenomyosis of the uterus\u2013revisited","volume":"112","author":"Bird","year":"1972","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.fertnstert.2018.01.006","article-title":"Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis","volume":"109","author":"Gordts","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1007\/s10815-022-02476-2","article-title":"Adenomyosis and infertility","volume":"39","author":"Moawad","year":"2022","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1002\/ijgo.15550","article-title":"Prevalence, incidence, and treatment trends of adenomyosis in South Korean women for 15 years: A national population-based study","volume":"167","author":"Park","year":"2024","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.jmig.2015.09.018","article-title":"Adenomyosis: A clinical review of a challenging gynecologic condition","volume":"23","author":"Struble","year":"2016","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1055\/s-0033-1350840","article-title":"Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy","volume":"73","author":"Taran","year":"2013","journal-title":"Geburtshilfe Frauenheilkd."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.fertnstert.2018.01.013","article-title":"Role of medical therapy in the management of uterine adenomyosis","volume":"109","author":"Vannuccini","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1080\/09513590.2016.1197200","article-title":"Adenomyosis: A systematic review of medical treatment","volume":"32","author":"Pontis","year":"2016","journal-title":"Gynecol. Endocrinol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.tjog.2021.09.010","article-title":"Minimally invasive adenomyomectomy via a laparoscopic-assisted approach compared to a laparoscopic or laparotomic approach","volume":"60","author":"Ahn","year":"2021","journal-title":"Taiwan. J. Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.tjog.2021.11.014","article-title":"A novel technique for myometrial defect closure after robot-assisted laparoscopic adenomyomectomy: A retrospective cohort study","volume":"61","author":"Hijazi","year":"2022","journal-title":"Taiwan. J. Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.fertnstert.2018.01.032","article-title":"Uterine adenomyosis and adenomyoma: The surgical approach","volume":"109","author":"Osada","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"50","DOI":"10.4103\/0972-9941.147690","article-title":"Robotic surgery in gynecology","volume":"11","author":"Sinha","year":"2015","journal-title":"J. Minim. Access Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.jmig.2005.12.004","article-title":"Laparoscopic adenomyomectomy and hysteroplasty: A novel method","volume":"13","author":"Takeuchi","year":"2006","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1002\/uog.14806","article-title":"Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: A consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group","volume":"46","author":"Dueholm","year":"2015","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1002\/uog.24786","article-title":"Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: Results of modified Delphi procedure","volume":"60","author":"Harmsen","year":"2022","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.jmig.2019.11.001","article-title":"Noninvasive diagnosis of adenomyosis: A structured review and meta-analysis of diagnostic accuracy in imaging","volume":"27","author":"Tellum","year":"2020","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_17","unstructured":"Jann, B. (2017). KMATCH: Stata Module for Multivariate-Distance and Propensity-Score Matching, Department of Economics, Boston College."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2436518","DOI":"10.1080\/01443615.2024.2436518","article-title":"Comparison of the efficacy of vaginal micronised progesterone tablet and gel for in vitro fertilisation","volume":"45","author":"Han","year":"2025","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/S0015-0282(97)00245-8","article-title":"Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device","volume":"68","author":"Fedele","year":"1997","journal-title":"Fertil. Steril."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1159\/000351431","article-title":"Efficacy of combined levonorgestrel-releasing intrauterine system with gonadotropin-releasing hormone analog for the treatment of adenomyosis","volume":"22","author":"Zhang","year":"2013","journal-title":"Med. Princ. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1111\/jog.14376","article-title":"The efficacy of medical treatment for adenomyosis after adenomyomectomy","volume":"46","author":"Li","year":"2020","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e15466","DOI":"10.1097\/MD.0000000000015466","article-title":"A comparison of surgical outcomes between robot and laparoscopy-assisted adenomyomectomy","volume":"98","author":"Shim","year":"2019","journal-title":"Medicine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.2147\/JPR.S205561","article-title":"Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: A long-term result in a single institution","volume":"12","author":"Zhu","year":"2019","journal-title":"J. Pain Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"106","DOI":"10.12659\/AJCR.881914","article-title":"Total uterine rupture during pregnancy after an adenomyomectomy","volume":"12","author":"Ukita","year":"2011","journal-title":"Am. J. Case Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/j.1447-0578.2007.00182.x","article-title":"Uterine rupture during pregnancy soon after a laparoscopic adenomyomectomy","volume":"6","author":"Morimatsu","year":"2007","journal-title":"Reprod. Med. Biol."},{"key":"ref_26","first-page":"1303","article-title":"Adenomyomectomy by uterine muscle flap method. Clinical outcome and investigation of the preventive effect on uterine rupture","volume":"84","author":"Osada","year":"2017","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"332","DOI":"10.5468\/ogs.21025","article-title":"Efficient myometrial defect closure in a layer by layer fashion after robot-assisted laparoscopic adenomyomectomy: A novel technique","volume":"64","author":"Hijazi","year":"2021","journal-title":"Obstet. Gynecol. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.jmig.2010.04.015","article-title":"Risk factors for uterine rupture after laparoscopic myomectomy","volume":"17","author":"Parker","year":"2010","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.jmig.2007.10.007","article-title":"Successful total laparoscopic cystic adenomyomectomy after unsuccessful open surgery using transtrocar ultrasonographic guiding","volume":"15","author":"Nabeshima","year":"2008","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.3349\/ymj.2016.57.6.1531","article-title":"Robot-assisted laparoscopic adenomyomectomy for patients who want to preserve fertility","volume":"57","author":"Chung","year":"2016","journal-title":"Yonsei Med. J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2120\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T05:33:42Z","timestamp":1773293622000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,10]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15062120"],"URL":"https:\/\/doi.org\/10.3390\/jcm15062120","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,10]]}}}