Technical Feasibility and Early Outcomes of Anatomical Laparoscopic Female Radical Cystectomy with Round Ligament Fixation to Prevent Vaginal Vault Prolapse

<i>Background and Objectives</i>: Vaginal vault prolapse is a known complication following anterior pelvic exenteration in women undergoing radical cystectomy. The aim of this study is to evaluate the feasibility, safety, and early outcomes of a novel anatomical approach for preventing vaginal vault prolapse after radical cystectomy. This study introduces a standardized laparoscopic technique that utilizes round ligament preservation and fixation to provide anatomical support to the vaginal apex. <i>Materials and Methods</i>: This study is a retrospective analysis of prospectively collected data from a single center, including thirteen female patients with uterus and adnexa in situ who underwent laparoscopic radical cystectomy with bilateral round ligament fixation to the vaginal cuff. The round ligaments were mobilized and sutured without tension. Vaginal closure was performed with barbed sutures. <i>Results</i>: No intraoperative complications occurred. At a median follow-up of 18.2 months, no cases of vaginal vault prolapse or dehiscence were observed. One patient experienced transient pelvic discomfort. <i>Conclusions</i>: This is the first report of a standardized mesh-free approach for vaginal apex support during laparoscopic anterior exenteration. The technique is feasible, safe, and may reduce postoperative prolapse risk.