Robotic uterine transposition for fertility preservation in patients undergoing pelvic radiotherapy: a narrative review of surgical evolution, technical strategies, and emerging evidence

Uterine transposition (UT) has emerged as a highly innovative fertility-preserving strategy for patients requiring pelvic radiotherapy. Unlike conventional approaches focused primarily on ovarian preservation, UT aims to protect both ovarian endocrine function and uterine integrity by temporarily relocating the uterus and adnexa outside the radiation field, followed by uterine repositioning after completion of oncologic treatment. While the feasibility of this procedure has been initially established through laparoscopic techniques, recent years have witnessed the introduction of robotic assistance, potentially offering advantages in surgical precision, visualization, and ergonomics during complex pelvic and upper abdominal dissection. This narrative review synthesizes the available evidence on robotic-assisted UT and contextualizes it within the previously published laparoscopic experience. The laparoscopic literature has defined patient selection criteria, operative principles, and early functional outcomes, demonstrating that UT can be safely integrated into multimodal oncologic treatment pathways. The emerging robotic experience, although limited to a small number of reported cases, confirms the technical feasibility of the procedure, with low perioperative outcomes and encouraging preservation of endocrine, reproductive and oncologic outcomes. Further evidence from prospective, multicenter experiences is required to define long-term outcomes and to clarify the role of robotic-assistance in this pioneering procedure.