OBJECTIVE: The aims of this study are to evaluate the oncological outcomes of robotic-assisted radical trachelectomy (RART) compared with radical vaginal trachelectomy (RVT) for localized early-stage cervical cancer in a national cohort. METHODS: RVT was introduced in 2003 in Denmark and nationally centralized to Copenhagen Univeristy Hospital. In 2014 the procedure advanced to a robotic-assisted approach. Perioperative and oncological data has been prospectively reported to the Danish Gynecological Cancer Database (DGCD) which is continuously developed and updated. All patients undergoing radical trachelectomy were included in this prospective cohort study. Data was extracted from DGCD and manually validated through electronic medical journals and The Danish Pathology Registry. RESULTS: A total of 206 patients underwent radical trachelectomy, with 78 patients undergoing RART and 128 patients undergoing RVT. No significant differences were observed in the microscopic free margins of the trachelectomy specimens. A total of seven (5.5%) patients undergoing RVT and two (2.6%) patients undergoing RART had recurrences (p = 0.403). No significant differences in recurrence-free survival were found between the groups, both in the unadjusted (HR 0.51 (0.11-2.47)) and adjusted analyses (HR 0.80 (0.16-3.96)). CONCLUSIONS: In this large single-center cohort, oncological safety of RART is equal to RVT for patients with localized cervical cancer and a fertility desire.