Modified Single-Port Laparoscopic Lateral Suspension with Bilateral 2-mm Micropunctures for Moderate-to-Severe Pelvic Organ Prolapse: A Prospective Single-Arm Feasibility Study

Background: Pelvic organ prolapse (POP) affects up to 40% of women over 50 years, with traditional surgical approaches carrying significant morbidity and suboptimal cosmetic outcomes. We evaluated the feasibility, efficacy, and safety of a novel modified single-port laparoscopic lateral suspension (LLS) technique using bilateral 2-mm micropunctures for moderate-to-severe POP. Methods: This prospective, single-arm feasibility study enrolled women aged 40-75 years with symptomatic POP-Q stage III-IV prolapse between January 2022 and December 2023 at Chengdu Integrated TCM&Western Medicine Hospital. The primary endpoint was 12-month anatomical success rate (POP-Q ≤ stage I) in patients completing follow-up. Secondary endpoints included patient-reported outcome measures (PFDI-20, PFIQ-7), cosmetic outcomes (POSAS), perioperative parameters, and safety profile. All procedures utilized a standardized technique with umbilical single-port access and bilateral 2-mm micropunctures for mesh manipulation. Results: Sixty patients were enrolled with 51 undergoing surgery (85% surgical rate). Thirty-eight patients completed 12-month follow-up (74.5% retention rate). The primary endpoint was achieved in 36 of 38 patients (94.7%; 95% CI, 87.6%-100.0%), significantly exceeding the pre-specified 80% success threshold. Mean operative time was 141.6±19.5 minutes with estimated blood loss of 44±15.2 mL. No conversions to multiport or open surgery occurred (0% conversion rate). Mean hospital length of stay was 5.9±0.7 days. Intraoperative complications occurred in 3 patients (5.9%), all Clavien-Dindo grade I-II. No mesh erosion or exposure occurred through 12 months. PFDI-20 scores improved significantly from baseline 210.5±14.2 to 51.2±12.6 at 12 months. PFIQ-7 scores decreased from 150.7±18.1 to 51.4±18.4. Patient cosmetic satisfaction was excellent with mean POSAS patient scores of 17.0±6.4 at 12 months. Conclusions: Modified single-port LLS with bilateral 2-mm micropunctures demonstrates excellent feasibility, efficacy, and safety for moderate-to-severe POP with superior cosmetic outcomes. The 94.7% anatomical success rate exceeds published benchmarks, while the single-port approach provides significant cosmetic advantages. These results support progression to randomized controlled trials comparing this technique with standard multiport approaches.