*Purpose: Living donor (LD) hysterectomy for Uterus Transplantation (UTx) can be performed robotically with vaginal extraction of the graft. There are no reports of the technical or functional outcomes of robotically procured grafts (RPG). This study reports outcomes from the largest series of UTx performed with RPG.

*Methods: Since 2016 to date, 20 of the 22 UTx performed at Baylor University Medical Center, Dallas, were from LD, 13 obtained through laparotomy (LG) and 7 through RPG. All 7 RPG were performed with The Xi Robot with vaginal extraction of the graft. Follow-up time of the RPG recipients range from 1-28 months.

*Results: All 7 RPG were successfully transplanted with a viable graft at 1 months post UTx, while 5 of the 13 LG resulted in early graft failure (within the first 2 postoperative weeks). In all RPG cases, a minimum of 3 of the 4 possible venous outflows (bilateral superior and inferior uterine veins) were procured and no uterine graft required vascular reconstruction. At the time of this report, 4 of the 7 RPG recipients have given birth to healthy babies (average of 13.3 months post UTx). The remaining three recipients are either currently pregnant or awaiting embryo transfer.

*Conclusions: Robotically procured uterine grafts from LD are associated with high technical success rate, no significant recipient complications and excellent outcomes in healthy live births.

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