Augmented Reality in Fertility-Preserving Minimally Invasive Gynecologic Surgery: Current Applications, Limitations, and Future Directions

Background: and Objectives: Augmented reality (AR) is increasingly being explored as an adjunct to image-guided minimally invasive surgery. In gynecology, its potential may be particularly relevant in fertility-preserving procedures, where the surgeon must balance adequate disease treatment with preservation of uterine architecture, reproductive anatomy, and future fertility potential. The aim of this review was to examine the current evidence on AR in minimally invasive reproductive gynecologic surgery, with a particular focus on myomectomy, adenomyomectomy, and endometriosis surgery, and to critically evaluate its limitations and future clinical role. Materials and Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and Google Scholar from database inception to March 2026. Search terms included combinations of “augmented reality”, “mixed reality”, “image-guided surgery”, “myomectomy”, “fibroid”, “leiomyoma”, “adenomyosis”, “adenomyomectomy”, “endometriosis”, “deep infiltrating endometriosis”, “fertility-preserving surgery”, and “reproductive surgery”. Eligible studies included original clinical studies, pilot studies, feasibility studies, case series, case reports, technical reports, and translational studies directly relevant to reproductive gynecologic surgery. Results: The available evidence is limited and consists mainly of feasibility studies, proof-of-concept reports, technical notes, and small observational series. The most developed reproductive applications of AR are currently found in myomectomy and adenomyomectomy, where MRI-based uterine modeling has been used to improve lesion localization and support tissue-sparing dissection. In endometriosis surgery, AR remains less mature as an intraoperative tool but appears promising for lesion mapping, anatomical orientation, and dissection planning. Across procedures, AR appears most clinically plausible as a tool for technical refinement and complication prevention rather than as a technology with proven superiority in perioperative or reproductive outcomes. Conclusions: AR is a promising adjunct in fertility-preserving minimally invasive gynecologic surgery, particularly in anatomically complex procedures requiring accurate lesion localization and tissue-preserving dissection. However, the current evidence base remains insufficient to support routine implementation. Future research should determine whether AR can improve operative precision, reduce complications, preserve uterine integrity, and ultimately influence fertility-related outcomes.