In a Q&A with IndiaMedToday, Dr Rooma Sinha, Honorary Professor and Director of Robotic Surgery at Apollo Hospitals, Hyderabad, breaks down the key findings from her 10‑year robotic myomectomy study. From an 86% pregnancy rate to reassuring data on uterine rupture and fertility‑preserving multi‑layer suturing, she explains how robotic surgery is redefining fibroid management and what it means for Indian women planning future pregnancies.
- What was the main goal of this 10-year robotic myomectomy study?
The primary aim of the study was to evaluate long-term reproductive outcomes in women undergoing robotic-assisted laparoscopic myomectomy (RALM) using the da Vinci Surgical System, thereby allowing us to assess fertility outcomes in a real-world cohort. While robotic myomectomy has increasingly been used for complex fibroids, long-term fertility outcomes have not been extensively studied, particularly in the Indian context.
In our research, we assessed the pregnancy rate following the procedure and also evaluated other key reproductive outcomes, such as live birth rates and the method of conception, whether spontaneous or through assisted techniques like IVF. We also analysed whether fibroid characteristics such as size, number, and location had any impact on fertility outcomes after surgery.
The broader objective was to understand how robotic myomectomy can support fertility preservation in women with symptomatic fibroids and provide real-world evidence that can guide clinical decision-making for both surgeons and patients.
2. What made you adopt robotic gynaecological surgery early, when many were still doubtful?
My interest in robotic gynaecological surgery stemmed from its potential to support greater surgical precision, particularly in complex cases involving large or multiple fibroids. Myomectomy requires careful dissection and meticulous reconstruction of the uterus, especially when fertility preservation is a priority.
Platforms such as the da Vinci Surgical System provide three-dimensional visualisation, high magnification, and articulated instruments that enable more controlled movements than conventional laparoscopy. These features can facilitate more precise suturing during uterine reconstruction, which is critical for maintaining uterine integrity.
For patients, minimally invasive approaches are also associated with several benefits such as reduced blood loss, shorter hospital stay and faster postoperative recovery. Taken together, these advantages encouraged me to adopt robotic surgery early, not only for managing complex cases, but also for bringing greater precision and consistency to more commonly performed gynaecological procedures, while preserving reproductive outcomes
3. How should women interpret the 86% pregnancy and 73% live-birth rates you reported?
In our study, we observed a pregnancy rate of 86.04% and a live-birth rate of 73.25% among women who underwent robotic myomectomy specifically for fertility enhancement. These outcomes suggest encouraging reproductive potential following well-performed fibroid surgery.
For women who are concerned about fertility after fibroid removal, these findings provide reassurance that successful conception is possible after surgery. In our cohort, pregnancies occurred both spontaneously and through assisted reproductive techniques such as IVF.
However, it is important to recognise that fertility outcomes depend on multiple factors, including age, overall reproductive health and the presence of other fertility-related conditions. While surgery can address fibroids effectively, individual outcomes may vary, and patients should discuss their specific situation with their treating specialist.
4. Why do you think there were zero uterine ruptures after these surgeries?
In our study, we did not observe any cases of uterine rupture during subsequent pregnancies. Several surgical factors likely contributed to this outcome.
One of the most important aspects of myomectomy is careful reconstruction of the uterine wall after fibroid removal. In our approach, the uterus is closed using meticulous multilayer suturing to restore structural integrity and ensure optimal healing. Minimising excessive use of electrocautery during dissection is also important to preserve tissue vascularity.
Preoperative planning using imaging, along with careful surgical technique, plays a significant role in achieving safe outcomes. Robotic platforms such as the da Vinci Surgical System can support this level of precise suturing, which is particularly important in fertility-preserving surgery.
5. In your data, which factors (age, fibroid size, location) most influenced fertility outcomes?
Interestingly, our analysis did not show a statistically significant relationship between pregnancy outcomes and either fibroid size or the number of fibroids removed. This finding suggests that even patients with larger or multiple fibroids may achieve favourable reproductive outcomes following well-performed myomectomy.
This is an important observation because many patients worry that complex fibroids might permanently affect their fertility. Our data indicate that surgical management can still be effective in such situations.
At the same time, fertility outcomes are influenced by several other factors, including age, ovarian reserve, underlying reproductive health and partner factors. For this reason, treatment decisions should always be individualised and made after a comprehensive evaluation of the patient’s fertility profile.
6. Why is multi-layer suturing so important for women who want to get pregnant later?
After fibroid removal, the uterus must be reconstructed carefully to ensure proper healing and restoration of its structural strength. Multilayer suturing allows the surgeon to close the uterine wall in successive layers, which helps distribute tension evenly and ensures better tissue approximation.
This approach is particularly important for women planning future pregnancies. During pregnancy, the uterus undergoes significant expansion and mechanical stress. A well-reconstructed uterine wall is therefore essential to safely support pregnancy and labour.
Meticulous suturing also helps reduce the risk of complications such as uterine rupture or poor healing. In fertility-preserving surgery, careful reconstruction of the uterus is just as important as the removal of the fibroid itself.
7. In which cases do you clearly prefer robotic myomectomy over laparoscopy or open surgery?
Robotic myomectomy can be particularly useful in complex clinical scenarios. These include cases involving large fibroids, multiple fibroids or fibroids located in challenging anatomical areas of the uterus. Many of these complex cases were reflected in our long-term study cohort, where robotic myomectomy enabled careful reconstruction even in patients with multiple or large fibroids.
The enhanced visualisation and instrument articulation provided by the robotic platform can help surgeons perform more precise dissection and suturing in these situations. This can be especially valuable when extensive uterine reconstruction is required.
Compared with open surgery, minimally invasive approaches may also offer benefits such as reduced postoperative pain, smaller incisions, shorter hospital stays and faster return to daily activities. Ultimately, the choice of surgical approach depends on the patient’s clinical profile, fibroid characteristics and the surgeon’s experience.
8. How has the trend of delayed motherhood changed the fibroid and fertility cases you see?
Over the past decade, delayed motherhood has become increasingly common as more women prioritise education, career progression and personal goals before planning families. This shift has had a direct impact on the type of fibroid cases seen in clinical practice.
Fibroids tend to become more prevalent with age, which means many women are now diagnosed at a stage when fertility preservation becomes a central concern. As a result, we are seeing more patients who require treatment for fibroids while also wanting to maintain their ability to conceive.
This changing demographic pattern highlights the importance of surgical approaches that can effectively treat fibroids while preserving reproductive potential and supporting future pregnancies.
9. When a patient asks, ‘Is the extra cost of robotic surgery worth it for me?’, how do you answer?
When discussing treatment options, it is important to consider the overall clinical context rather than focusing solely on the initial procedural cost. The most appropriate surgical approach depends on the complexity of the fibroids, the patient’s reproductive goals and the surgeon’s expertise.
Minimally invasive approaches, including robotic surgery, may offer benefits such as reduced blood loss, shorter hospital stays and faster recovery for many patients. These factors can contribute to a smoother postoperative course and quicker return to daily activities.
Ultimately, the decision should be made after a detailed discussion between the patient and the treating surgeon, considering both the medical aspects and the patient’s individual circumstances.
10. What minimum training should a gynaecologist have before performing robotic myomectomies independently?
Robotic surgery requires structured and progressive training before a surgeon begins performing procedures independently. This typically includes formal educational modules that cover the technology and surgical techniques, followed by simulation-based training to develop technical skills.
Hands-on laboratory practice and observation of live procedures are also important components of the learning pathway. Many surgeons also undergo proctorship during their initial clinical cases, where experienced mentors guide them through the early phase of their robotic surgery experience.
Developing proficiency in robotic surgery takes time and practice, and surgeons must ensure they have adequate training and experience before performing complex procedures independently to maintain patient safety.
11. What changes in insurance or hospital policy are needed to make robotic surgery more accessible for Indian women?
Improving access to advanced surgical technologies will require broader policy and insurance support. While some insurance providers have begun recognising minimally invasive procedures, wider inclusion of such treatments in insurance coverage would help more patients benefit from these options.
Hospitals also have an important role to play in expanding access by developing structured robotic surgery programmes and investing in training for surgeons. As surgical teams gain experience and programmes expand across more centres, access to these technologies can gradually improve.
Greater awareness among both patients and healthcare providers about modern surgical options can also contribute to better access and more informed decision-making.
12. What is your key message to women with fibroids who are worried about their fertility and surgical options?
Women diagnosed with fibroids should know that effective treatment options are available and that many women can conceive successfully after appropriate surgical management. The most important step is to consult a specialist who can carefully evaluate the fibroids and assess the patient’s overall reproductive health.
Treatment decisions should always be individualised, taking into account the size, number and location of the fibroids as well as the patient’s fertility goals. With careful surgical planning and appropriate management, it is often possible to treat fibroids while preserving fertility.
Early evaluation and timely treatment can make a meaningful difference in protecting reproductive health and supporting future family planning.
