Design: The study aims to describe the implementation of UPS as a minimal invasive mesh-free apical fixation.

Setting: Patient is positioned in standard position for robotic surgery: lithotomy position, legs in leg support systems, arms tucked next to the body, Trendelenburg position (25 degrees).

Patients or Participants: Patients with grade 2-4 POP were included in the study.

Interventions: UPS is a standardized technique of 5 steps to restore the natural anatomical position of the uterus or vaginal cuff. After identifying the cranial part of the pectineal ligament, a non-absorbable suture is placed for lateral fixation. By manipulation of the uterus or cuff intraoperatively, the ideal anatomical reconstruction is simulated. After dissecting the bladder, the medial fixation of the suture is placed, followed by a tension free suspension to restore the physiological anatomy.

Measurements and Main Results: In comparison to the standard surgical techniques for POP, UPS provides several advantages. The medial tension-free apical placement combined with normal pelvic floor mobility and the restoration of the vaginal axis allows for normal vaginal function. The technique provides maximum safety, significant reduction of operative time and avoidance of ureter, bowel and hypogastric nerve dissection. This procedure can be performed in a same day discharge setting (SDS).

Conclusion: UPS is a highly efficient minimal-invasive mesh-free surgery, avoiding the need of a hysterectomy. Reliable level one support is achieved, respecting the natural anatomy. This technique can easily be implemented, resulting in efficient and innovative surgical POP treatment.