Gynecology Center of the Krasnodar Municipal Medical and Diagnostic Association (Chief Physician - I.M. Khankoev, MD), Director - Professor B.I. Kazakov, MD, PhD, K.V. Spiropoupos, and O.A. Magerlamov. Among all gynecological diseases, prolapse of the uterus and vaginal walls is a common pathology, with an incidence of 15-20%. The etiology of this pathology is dominated by complicated or multiple births, prolonged inflammatory processes of the internal genital organs, age-related changes in the structure of muscle and connective tissue in the premenopausal period due to estrogen deficiency, gastrointestinal diseases, and heavy physical labor. Conservative treatment (bandages, vaginal pessaries) is generally not very effective. Traditional surgical treatment (usually anterior and posterior colpoperineorrhaphy plus laparotomy (fixation of the uterus to the aponeurosis, ligament triplication, and other techniques) depends on the surgical scope, anesthesia, and postoperative period, especially in patients with concomitant cardiovascular and respiratory diseases. This increases the risk of complications at all stages of treatment. With the development of endoscopic surgical techniques, the advantages of minimally invasive methods, such as less trauma, less contact with abdominal organs, a significant reduction in purulent-septic complications, a significant reduction in operative time, and other benefits, have led to the development of a number of laparoscopic uterine fixation procedures, including McCall vaginopexy, MESH vaginopexy, and sacrovaginopexy. Our goal was to provide early surgical care to women with mild to moderate uterine and vaginal prolapse, as well as to use our laparoscopic uterine fixation technique in combination with vaginal surgery for severe uterine and vaginal prolapse, including complete uterine prolapse in sexually active women. The choice of videolaparoscopic surgical correction method was based on the following: the extent of the pelvic diaphragm lesion, the degree of uterine and vaginal prolapse, the patient's age, sexual activity, and urinary and bowel dysfunction. The objectives included correcting the anatomical and topographic defect, restoring the pelvic architecture as close to normal as possible, creating conditions for the normal functioning of the genitals, and correcting urinary tract dysfunction. Using a developed technique for videolaparoscopic uterine fixation, surgeries were performed on patients with mild and moderate prolapse, as well as on patients with severe uterine and vaginal wall prolapse in sexually active women. These patients underwent traditional anterior and posterior colporrhaphy with levator plasty and simultaneous videolaparoscopic uterine fixation to the aponeurosis. The essence of the developed and patented (Patent No. 2076645, April 10, 1997) technique for videolaparoscopic uterine fixation in cases of uterine and vaginal wall prolapse using specialized instruments is as follows. Patients with this genital pathology underwent videolaparoscopy, during which the abdominal organs were examined. During video laparoscopy, an assistant inserted a special probe through the vagina to move the uterus upward, positioning it so that any existing prolapse of the uterus and vaginal walls was corrected. This position was indicated using a laparoscope [https://eleps.ru/katalog/laparo-i-torakoskopiya-optika/] brought to the new position. A strong light illuminated the anterior abdominal wall, highlighting this point. A mini-incision was made 2-3 cm above the uterine aponeurosis. A special needle-awl loaded with a lavsan thread was inserted through a mini-incision in the anterior abdominal wall. Under video laparoscopic control, the uterus was punctured in the fundus, slightly shifting the puncture site toward the uterine angle. The thread was then removed from the needle using a clamp through the laparoscope's surgical channel and left in the abdominal cavity. The awl-needle was removed from the abdominal cavity, and then the aponeurosis was re-punctured through an incision on the anterior abdominal wall, 1.5 cm from the previous puncture site, this time with an unloaded thread. In the abdominal cavity, the uterus was punctured at the fundus on the other side under laparoscope control, 1.5-2 cm from the previous puncture site, using the awl-needle without thread. Then, the Mylar thread, left in the abdominal cavity, was clamped into the hole of the empty awl-needle, passed through the fundus of the uterus, and the needle and thread were removed through the incision on the anterior abdominal wall. Holding both ends of the thread, under laparoscope control, the uterus was pulled toward the parietal peritoneum of the anterior abdominal wall, and the Mylar thread was tied. This resulted in the Mylar thread fixing the uterus to the peritoneum and aponeurosis with a U-shaped suture. The incision on the anterior abdominal wall was sutured with one or two sutures or a subcutaneous suture. The surgery lasted 10-12 minutes. A total of 203 patients were operated on. The age ranged from 38 to 78 years. The duration of the disease ranged from 2 to 17 years. The group of women with mild to moderate prolapse of the uterus and vaginal walls consisted of 73 patients. These patients underwent only laparoscopic fixation of the uterus to the aponeurosis. The surgery lasted 10-12 minutes. The postoperative period was uneventful. Hospital stay was 4-5 days. Work capacity was restored after 10-12 days. Videolaparoscopic fixation of the uterus in combination with anterior and posterior colporrhaphy was performed in 130 patients with significant prolapse of the uterus and vaginal walls in sexually active women. There were no intraoperative complications. In cases where videolaparoscopic fixation alone was performed without anterior and posterior colporrhaphy, patients were able to get up within the first day. A follow-up examination was performed 1-1.5 months after surgery, during which a vaginal examination and ultrasound were performed. In two cases, recurrence of uterine and vaginal wall prolapse was observed (one of these occurred in the first patient to undergo surgery using this technique, and this was likely due to the patient's learning curve). In other patients, who underwent surgery using this technique, either alone or in combination with anterior and posterior levatorplasty, no complications were observed. Pain disappeared, and the ability to work with moderate exertion was restored.