Surgical management of Pelvic Organ Prolapse (POP) with retention of the uterus has become popular. Traditionally, laparoscopic treatment was carried out by means of sacrocolpopexy or sacrouteropexy. We propose an original laparoscopic surgical treatment by modification combining laparoscopic pectopexy and uteropexy using a polyvinylidene fluoride (PVDF) monofilament mesh (e.g. DynaMesh-PRP visible 17 x 15 cm ). To our knowledge, it is the first publication on laparoscopic colpo-hysteropectopexy  combinig these two techniques.

We considered a 53 years old patient with apical POP diagnosed with stage III apical prolapse in accordance with the POP quantification system of the International Continence Society (ICS): POP- Q: Aa-1.0, Ba 3, C 1.5, gh 4, pb 3, tvl 9, Ap-3, Bp-3, D-3.5. Laparoscopy was performed under general anesthesia.  One 11 mm suprapubic port, two 5 mm lateral ports and 12 mm (Hasson) umbilical port were used.We divided the posterior portion of the mesh in two additional central arms. In that case the two central arms of the bifurcated mesh were introduced through bilateral windows created in the broad ligaments and sutured together. The central body of the mesh was fixed with non absorbable suture material (Premicron) to the previously dissected vaginal apex. The lateral arms of the mesh were then attached to both iliopectineal ligaments with non absorbable Premicron sutures. Finally, the entire mesh was covered with the peritoneum, using absorbable suture material.

With an operation time of 110 minutes, and 50 cc blood loss, the patient was discharged 48 h later. The patient reported full resolution of her POP and was confirmed by clinical evaluation. No urinary stress incontinence neither constipation de novo were observed.

Laparoscopic Colpo-Hysteropectopexy could be an attractive option in the treatment of POP in women who desire to retain their uterus. The use of a bifurcated mesh and the fixation by passing the central arms of the mesh through the windows in the broad ligament and the fixation of the central part to the vaginal apex and to the bilateral iliopectineal ligaments could provide a steady support of the vaginal apex and uterus. We believe that this technique yields a durable and satisfactory anatomical functional result.