Robotic uterine transposition and reposition in a patient with rectal cancer: complete case report and surgical perspective.

Uterine transposition (UT) is an emerging fertility-preserving technique for women requiring pelvic radiation. We report our first complete robotic UT followed by successful robotic uterovaginal anastomosis (uterine reposition, UR) in the multimodal treatment of rectal adenocarcinoma. A 29-year-old nulligravid woman with locally advanced rectal cancer underwent robotic UT in February 2024 prior to neoadjuvant chemoradiation. The uterus and adnexa were transposed to the upper abdomen with preservation of vascular supply, perfusion confirmed by fluorescence angiography, and a temporary neocervical canal created at the umbilicus. In March 2025, robotic UR was performed concurrently with abdominoperineal resection and end colostomy. Surgery was completed without intraoperative complications. Pathology revealed mucinous adenocarcinoma with one positive lymph node and negative margins. Despite later systemic recurrence, the uterus remained viable and menstruation resumed through the native cervix. This case demonstrates the feasibility of robotic UT and UR for fertility preservation in complex oncologic care.