목적: To determine the long-term efficacy of laparoscopic or robotic adenomyomectomy with or without gonadotropin-releasing hormone agonist for the treatment of severely symptomatic adenomyosis. 방법: Between August 2008 and May 2011, 33 patients underwent laparoscopic or robotic adenomyomectomy with uterine artery ligation for the treatment of symptomatic adenomyosis. Seventeen patients (52%) received 3-course gonadotropin-releasing hormone agonist treatment after adenomyomectomy. 결과: The mean operating time was 147.4 ± 52.0 min, and the mean blood loss was 36.1 ± 37.4 mL. Postoperative complications occurred in 5 patients, including 4 cases of febrile morbidity, 1 case of ileus, and 1 case of pelvic abscess. Patients had statistically significant symptom relief during the 3-year follow-up period. Four of the 33 total patients (12%) showed symptom relapse; 3 patients showed a relapse with dysmenorrhea and 1 patient showed a relapse with menorrhagia. There were no significant differences in terms of therapeutic outcomes between surgical-only and surgical-medical treatment. 결론: Laparoscopic or robotic adenomyomectomy was feasible and safe for women with severely symptomatic adenomyosis who wished to preserve the uterus. Moreover, this procedure provided long-term symptom control, regardless of postoperative gonadotropin-releasing hormone agonist administration.