Laparoscopic Psoas–Round Ligament Fixation (Rotundum Hitch): A Mesh-Free Native Tissue Technique for Uterine Prolapse

Pelvic organ prolapse (POP) is commonly treated with sacrocolpopexy or native tissue repairs, but mesh-related complications and recurrence remain concerns. We describe a novel mesh-free uterine-preserving technique, Laparoscopic Psoas–Round Ligament Fixation (Rotundum Hitch, RH). This prospective single-center study included women with symptomatic uterine prolapse (POP-Q stage II–IV) who underwent laparoscopic RH. The round ligaments were mobilized bilaterally and fixed to the ipsilateral psoas fascia using nonabsorbable sutures. Patients were evaluated at 6 weeks, 6 months, and 12 months. Primary outcomes were procedural feasibility and perioperative safety. Secondary outcomes included POP-Q measurements, UDI-6 scores, and recurrence. Twenty women underwent RH, and all procedures were completed laparoscopically without conversion. Mean operative time was 45 ± 9 minutes, with minimal blood loss and no major intraoperative complications. One urinary tract infection and one transient postoperative thigh discomfort resolved with conservative management. At 12 months, 18 patients were available for follow-up; 17 (94.4%) maintained anatomical success (POP-Q stage < II). Significant improvements were observed in POP-Q measurements, including point C, and UDI-6 scores improved significantly ( p < 0.001). Laparoscopic psoas–round ligament fixation appears to be a feasible and safe mesh-free uterine-preserving technique with encouraging short-term anatomical and functional outcomes. Larger comparative studies with longer follow-up are needed to evaluate long-term durability.