Balancing Fertility and Oncologic Uncertainty: Robotic Myomectomy With Bilateral Uterine Artery Ligation for Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP)

Smooth muscle tumor of uncertain malignant potential (STUMP) is a rare uterine neoplasm characterized by ambiguous histopathological features and unpredictable clinical behavior. Management is particularly challenging in young, nulliparous women, where the standard approach of hysterectomy conflicts with fertility preservation. We report a case of a young nulliparous woman who underwent fertility-preserving robotic myomectomy with bilateral uterine artery ligation for a presumed atypical leiomyoma, later diagnosed as STUMP on histopathology. This case highlights the diagnostic limitations of preoperative assessment, the intraoperative decision-making involved in fertility-sparing surgery, and the role of robotic-assisted techniques in optimizing surgical precision and uterine preservation. In the absence of standardized management guidelines, treatment of STUMP requires individualized decision-making, balancing oncologic risk with reproductive goals. Careful patient selection, multidisciplinary evaluation, and long-term surveillance are essential. This case supports the feasibility and safety of a conservative robotic approach in selected patients.