Symptomatic pelvic organ prolapse (POP) also affects younger women. If conservative therapies fail, reconstructive surgical therapies come into question, which depends on several factors. In addition to the correction of the affected anatomical structures, the patient's desire or preference with regard to uterine preservation and desire for fertility preservation must also be taken into account.
In the last 2 decades, attitudes toward and interest in uterus-preserving POP surgery have increasingly changed. Uterus-preserving procedures have the advantage of significantly shorter operative time, less blood loss, as well as faster recovery and the possibility of fertility preservation. There are a variety of uterus-preserving surgical options, but so far there are no prospective data for a bilateral procedure with a clearly defined surgical procedure using a minimum of synthetic mesh material.

We present the first interim results of a minimally invasive uterus-preserving surgical technique with bilateral replacement of the uterosacral ligaments (USLs) as part of a prospective study. In comparison to unilateral hysteropexy, only a minimum of synthetic material (16 cm2) is implanted in clearly defined anatomical structures in order to achieve better reproducibility and comparability of clinical results.

A total of n=163 patients will be included in this prospective, multicenter study. The primary objective is the anatomical recurrence rate (POP-Q stage >1), secondary objectives are incontinence, postoperative pain, constipation, etc. in addition to mesh-specific complications. Follow-up intervals are at least every 6 months.
In laparoscopic uterosacropexy (laUSA), both USLs are replaced by a defined PVDF structure. These bands are implanted retroperitoneally in the course of both USLs between the posterior cervix and sacrum (Fig. 1).

The feasibility and safe practicability of laUSA has been demonstrated in 10 patients included to date. Apical support (POP-Q stage 0) was restored in all 10 patients. No intraoperative complications occurred (vessel or ureter injury and bowel or bladder lesions). Blood loss was less than 20 mL per patient, and the mean operation time was 49 minutes. Within follow-up, no mesh erosions or relapse of prolapse were detected.

In this first interim analysis, the feasibility and safe performance of this bilateral apical fixation was demonstrated despite the small number of cases and short follow-up. Beside the advantage of fertility preservation in addition to shorter surgical time, low blood loss, and faster convalescence, the minimal use of synthetic material may also represent an alternative treatment option for premenopausal patients.