Round Ligament Pulley—A Novel Technique of Sling Surgery

Abstract

Background: Uterovaginal (UV) prolapse is a common gynecological disorder often affecting women in their reproductive years. While traditional surgical treatments such as vaginal hysterectomy and Manchester repair are effective, they are not suitable for women wishing to preserve their fertility. This article introduces a novel, conservative surgical technique—Round Ligament Pulley Sling Surgery—aimed at treating UV prolapse while preserving reproductive potential. Methods: This case series was conducted over a period of 10 years (2004–2024) and involved 200 women with Stage II or III uterovaginal prolapse. The surgical technique utilized the patient's own round ligament as a supportive sling to reposition the uterus. Patients were selected based on their desire for fertility preservation and absence of cervical elongation. Outcomes assessed included procedural success, complications, future fertility, and delivery outcomes. Results: All procedures were successful, with no intra- or post-operative complications. Minimal blood loss and a short operative time were noted. During one-year follow-up, 56 women conceived, and 49 delivered vaginally. No adverse reproductive or functional outcomes were reported. Conclusion: The Round Ligament Pulley technique is a safe, simple, and effective fertility-preserving surgical option for uterovaginal prolapse. It demonstrates excellent clinical outcomes and allows for vaginal delivery post-surgery.