A novel operation for pelvic organ prolapse (POP) with native tissue repair (NTR) : laparoscopic reconstruction of cervical triangle zone (CTZ) and round ligament colpopexy (LRLC)

Abstract

Native tissue repair (NTR) is becoming the cornerstone of the surgery for pelvic organ prolapse (POP) to avoid serious mesh related complications. We used intrafascial dissection technique (Aldridge’s method) for total laparoscopic hysterectomy (TLH). Cervical triangle zone (CTZ) defined by the apex (a part of cardinal ligament containing arteriovenous bundle of internal uterine os), sides (fascia) and the base (the part of uterosacral ligament and uterovesical ligament), is created during the operation. Reconstruction of CTZ was proposed as a novel procedure for uterine prolapse (lower than POP-Q stage II) and vaginal prolapse after TLH. In addition, laparoscopic fixation of the vaginal stump and round ligament produced a vaginal wall suspension, which is named as laparoscopic round ligament colpopexy (LRLC). Laparoscopic reconstruction of CTZ and LRLC may provide an additional option for the treatment of POP. Surgical technique of CTZ and LRLC were described in this report.