Pelvic floor dysfunction disease refers to the dysfunction of the pelvic floor tissues and organs, in women, it mainly includes uterine prolapse, anterior and posterior vaginal wall bulge, bladder neck and urethra downward displacement to stress urinary incontinence, rectal prolapse, etc. The causes of this disease are mainly of two types, one refers to its own tissue and structural defects, the other refers to the injuries (birth trauma and traumatic injury), and the main treatment is to use the structural reconstruction or corrective strategies, and the current laparoscopic application in the field has achieved good clinical results, and several new surgical methods are introduced below. The application of laparoscopy in this field has achieved good clinical results, the following introduces several new surgical methods. 1, the uterine prolapse of laparoscopic surgery uterine prolapse of many surgical methods, at present can be completed under the laparoscopic and better surgical methods include, uterus and vagina sacral capsule fixation, uterosacral ligament folding and shortening, uterus and vaginal dome sacrospinous ligament fixation. 1.1 Indications and contraindications Uterine prolapse, combined with anterior and posterior vaginal wall bulging by conservative treatment is ineffective, and seriously affect the patient’s quality of life, the need for surgical treatment. Those who have serious lung disease and chronic cough, chronic constipation and heavy laborers are not suitable for surgical treatment. Those with contraindications to laparoscopy should not undergo laparoscopic surgery. 1.2 Uterine cervix and vaginal mesh sacral capsule fixation (1) Separation of the retroperitoneal space: firstly, separate the vesicovaginal space or vesico-uterine space, which is bounded by the bladder pillars, and both bladder pillars converge at the base of the bladder and are located at the same level as the ureter, which is incised and separated from the medial midline of the bladder pillars. To separate the rectovaginal space, the lateral peritoneum is first opened and the ureters are located and then pushed away from the sacral ligaments. Identify the junction of the bilateral sacral ligaments located in the recto-uterine recess, lift the peritoneum, cut the peritoneum of the recto-uterine recess, and separate the rectovaginal space. The area of separation is required to reach forward and down to about 2 cm above the perineal union. The broad ligament is perforated, the uterus is lifted and pushed to the other side, and the posterior lobe of the broad ligament is opened so that the anterior and posterior lobes of the broad ligament can be connected for placing the mesh for repair. (2) Exposure of the sacral promontory: The best way to expose the sacral promontory is to carefully push away the sigmoid colon in a head-down-hip-high position, and the sigmoid colon can be fixed to the anterior abdominal wall to improve the field of view. The right ureter and common iliac vein are identified, and the ureter is freed and exposed by vertical incision of the posterior peritoneum from the sacral promontory. Continue to separate the posterior peritoneum to lumbar 5 or above sacral 1, separate the anterior ligament of the vertebrae, and push away the artery and the median sacral vein within it. (3) Placement of the repair mesh: The Mersilene mesh is used because it is strong and has better longitudinal extension than transverse, and does not remain fixed, which facilitates laparoscopic operation. If the uterus has been resected, the mesh is firstly placed into the posterior area, and the gap between the mesh and the vagina is closed by sewing the mesh to the vagina with nylon threads; the anterior wall of the vagina is then covered and sutured to the anterior wall of the vagina. If the uterus is not removed, the mesh is placed behind the vagina and fixed to the vaginal part of the uterus and the main ligaments with size 0 non-absorbable nylon sutures. (4) Recto-uterine plication: the aim is to raise and reposition the rectum and pull the vagina posteriorly. This involves closure of the posterior dome and the recto-uterine sulcus, which can be closed with 2 stitches. The uterosacral ligament is closed posteriorly. The ureter is first identified and the main ligament is closed. Finally, the mesh is sutured to the vagina and the opposite side is treated in the same way. (5) Fixation of the mesh: the mesh is spread in the vesicovaginal space. If the uterus has not been removed, the two wings of the mesh are passed through the hole made in the posterior lobe of the broad ligament. A wide knot is tied behind the isthmus, where there is no peritoneum at the time of separation of the rectovaginal space, and the mesh is secured to the anterior vaginal wall with 2/0 nylon thread and the knot is tied. (6) Sacral cape fixation: Fix the anterior and posterior mesh to the anterior ligament of the sacral cape and the periosteum of the sacral cape, and only enter the fibrous layer of the tendon membrane to avoid vertebral plagiocephaly and perforation of the spine. The sutures are checked to ensure that they are secure. Pelvic peritonealization: The incision is made in the front of the vesico-uterine separation surface and the back of the rectovaginal separation surface, and in the middle of the incision from the sacral promontory to the midline of the recto-uterine pit. 2/0 nylon thread and curved needle are used to close the incision with 2-3 stitches, and the suture is tied with a knot, or a steel staple can be used. (7) Peritonization of the posterior peritoneum: After the sacral promontory is sutured, the polypropylene mesh is placed in the right pararectal space behind the peritoneum, and the posterior peritoneum is closed. 1.3 Folding and shortening of the uterosacral ligament (1) Separation of the lateral peritoneum: first identify the course and position of the ureter, open the lateral peritoneum, free and push away the ureter, so as not to injure the ureter when suturing the sacral ligament. (2) Folding and shortening of the uterosacral ligaments: U-shaped folding sutures were performed along the uterosacral ligaments on both sides, the rectovaginal septum and the vaginal wall, and the uterosacral ligaments were shortened, and then successive sutures were made to the top of the vagina and to the junction of the sacral ligaments bilaterally and were fixed to the vaginal fascia, so as to strengthen the pericervical fascial ring on the both sides and the posterior part of the cervix. (3) Fixation of uterosacral ligament: the folded uterosacral ligament was sutured at the level of cervix with non-absorbable No. 0 nylon thread, fixed on both sides, and then knotted after suturing. (4) Closure of the uterorectal fossa: The uterosacral ligaments were closed by intermittent suturing with No. 0 nylon thread to close the uterorectal fossa. If the ureter is twisted after suturing the uterosacral ligament, open the pelvic side of the pelvic peritoneum on the inner side of the sacral ligament, free and push away the ureter, so as to make it travel naturally. 1.4 Fixation of cervical and vaginal vault sacrospinous ligament (1) Separation of gap: similar to vaginal sacral fixation, first separate the cervical and paravaginal gap to expose the fascial tissues above the sciatic spine. The rectovaginal space is then separated by opening the lateral peritoneum, identifying the ureter and pushing it away from the uterosacral ligament to avoid injury. Identify the junction of bilateral sacral ligaments located in the recto-uterine recess, lift up the peritoneum, cut open the peritoneum of the recto-uterine recess, and separate the recto-vaginal hiatus. (2) Separation of the perirectal space: on the medial side of the uterosacral ligament, extend the peritoneal incision of the rectovaginal recess to the anterior aspect of the second and third sacral bones, separate and push away the rectum, and expose the bilateral sacrospinous ligaments, caudal muscles, and sciatic spine. (3)Suture the posterior wall of cervicovaginal part or posterior vaginal wall on both sides respectively, pass the suture line through the coccygeal muscle and sacrospinous ligament 2-3cm from the medial side of the sciatic spine, the suture line of sacrospinous ligament on each side should not be more than 2 stitches, and then tie a knot to fix the posterior vaginal wall or the cervicovaginal part to the sacrospinous ligament. 1.5 Precautions and common complications (1) traumatic hemorrhage and vascular injury: including traumatic hemorrhage during the separation of each gap, injury to the presacral venous plexus during the suturing of sacrospinous ligament, and injury to the uterine artery during the perforation of broad ligament, the traumatic hemorrhage and injury to the uterine artery can be hemostatized by bipolar coagulation, and the suture can be closed to stop the hemorrhage if necessary. As for the injury of presacral vein, it depends on the size of the laceration, if it is a small laceration, only compression or bipolar electrocoagulation can be used to stop the bleeding, if it is a small laceration, it can be tried to be sutured laparoscopically, if it is difficult to be sutured or the laceration is large, it can be used to perform vascularization by laparoscopic suturing or anastomosis. (2) Ureteral injury: If there is ureteral injury, ureter and ureter or ureter and bladder anastomosis can be performed, and ureteral stent can be placed after surgery to prevent ureteral stenosis. The stent is usually removed about 3 months after surgery. (3) Intestinal obstruction: The small intestine enters the rectal recess due to incomplete closure of the rectal recess, forming an internal hernia of the small intestine and an intestinal obstruction. Mild internal hernia can be relieved automatically by conservative treatment, but in severe cases, intestinal necrosis can occur and surgery is needed. Therefore, the closure of rectovaginal depression should be done thoroughly, leaving no gap to avoid the occurrence of intestinal hernia. 1.6 Surgical evaluation of genital tract prolapse is a common gynecological disease, currently used in the treatment of this type of disease more than 30 kinds of surgical methods, which is sufficient to illustrate the intractability of this type of disease. Laparoscopy only provides a new means of transabdominal surgery, which can make better vision when separating the anterior and posterior gaps. This kind of new procedure combines the traditional vaginal or cervical fixation with a new surgical pathway, which achieves the effects of minimally invasive, precise tissue separation and fast recovery, and has a good clinical application prospect. However, due to the difficulty of laparoscopic surgical operation, which limits its clinical application, it is necessary to strengthen the training of laparoscopic surgical suture technique so that more gynecological laparoscopists can master the technique and serve in the clinic. 2, stress urinary incontinence laparoscopic surgical treatment Stress urinary incontinence surgery is also a variety of surgical methods, but the purpose of surgery is mainly to correct the urethra of the lack of support, in order to alleviate the symptoms of urinary incontinence. Laparoscopic surgery with bladder neck and mid-urethral suspension is most commonly used, and the results are good. 2.1 Indications and contraindications. Tension incontinence of degree II or above can be treated with surgery if conservative treatment is ineffective or recurrent. Those with contraindications to laparoscopic surgery are not suitable for laparoscopic surgery. 2.2 Burch bladder neck suspension (1) Separation of the retropubic Retzius space: there are two routes, i.e. the transabdominal route and the extraperitoneal route. Transperitoneal route: peritoneal incision from one side of the umbilical artery to the other side of the umbilical artery, fully free the anterior interstitial space of the bladder, the bladder should be filled for the bladder revealing difficulties. Then continue downward to free the retropubic fascia, open the Retzius space, expose the pubic bone and bilateral Cooper’s ligaments, and reach the bladder neck. The bladder is pushed back medially with a separating forceps, while the vaginal wall tissue is grasped with a grasping forceps on the opposite side to completely separate the bladder from the vagina and expose the anterior vaginal wall. Extraperitoneal route: At the midpoint between the umbilicus and the umbilicus, a 2-cm-long horizontal incision was made to bluntly separate the Retzius space under the rectus abdominis muscle on both sides to the Cooper ligament, which could be done by inserting a 1,000 to 1,500 ml balloon into the space or by bluntly separating the fingers. A 5-mm trocar is then inserted in each side, and a set of trocars is placed in the pubic bone for retraction. The rectus abdominis muscle was sutured around the 10-mm trocar and then inflated with low-pressure (8-12 mmHg) air in the Retzius space. (2) Suture: Firstly, suture the Cooper ligament, try to pass through the whole layer of the Cooper ligament to enhance its resistance to tension, and exit the needle in the direction of its longitudinal axis, do not force the needle to avoid breaking the needle. Insert the middle finger or index finger of the left hand into the vagina to expose the urethrocystic connection and the needle point of the anterior vaginal wall that will be sutured, use the finger as a guide to insert the needle and avoid the bladder to puncture the tissue of the anterior vaginal wall, but avoid penetrating the whole layer. Tighten the suture after the needle is removed, and tie the knot so that the urethrocystic connection does not form an acute angle. The first suture must be close to the urethrocystic connection, and then the second and third suspension sutures should be closed sequentially, with an interval of about 1 cm between each suture. If there is bleeding on the wound surface, bipolar electrocoagulation can be used to stop bleeding, if necessary, suture hemostasis, rinse the wound surface, thoroughly check the inactivity of bleeding, that is, intermittent suturing of the peritoneum with absorbable sutures. 2.3 Mid-urethral sling suspension (1) preparation of the sling: there are two kinds of materials, i.e., autologous tissues and synthetic materials, synthetic materials because of infection, erosion and high chance of rejection by the body, so most of them are used in their own tissues (autologous grafts) or allogeneic tissues denatured and processed materials (allogeneic grafts). Cutting of autologous or allogeneic fascial band tissue: The strong tendon on the surface of the rectus abdominis or quadriceps muscle of the thigh is cut, the length is about 10cm, the width is about 1cm, and after taking out the tendon tissue, the local area is bandaged with gauze to stop the bleeding, and there is no obvious discomfort to the patient after the operation due to the small incision. If the patient’s body is weak or older, then use allogeneic tissue as a sling, the effect is the same as autologous tissue. Preparation of synthetic materials: Polypropylene mesh or nylon mesh is generally used, cut into strips. (2) Placement of the sling: the sling is placed into the retropubic space through the puncture sheath hole of the laparoscope, and the retropubic space is freed and completely hemostatized through the laparoscope beforehand, so as to separate the bladder and ureter, as well as the junction of the ureter and the bladder. At this point in the anterior wall of the vagina bladder neck position with a scalpel longitudinal incision of the vaginal mucosa and submucosal part of the muscle layer, with the pointed vascular forceps from this incision along the vaginal mucosa inserted, in the side of the bladder neck into the retro-pubic space, the vascular forceps to grasp the sling at the end of the sling, clamping and pulling the vagina; at this time, clamping the sling of the vascular forceps from the other side of the vaginal mucosa under the vaginal wall through the vagina wall tissue gap, in the other side of the bladder neck. into the retropubic space. (3) Suture of the sling: Use No. 0 nylon thread with needle to suture the two ends of the sling to Cooper’s ligament bilaterally, the tension of the sling should not be too great after suture, i.e., the urethra should not form an acute angle. (4) Close the posterior peritoneum and vaginal mucosa, and intermittently suture the peritoneum with absorbable sutures. Then close the vaginal incision with absorbable suture. 2.4 Precautions and common complications (1) bleeding and vascular injury: when opening the posterior peritoneum, attention should be paid to prevent bleeding from injury to the arteries under the abdominal wall, if any, bipolar electrocoagulation can be used to stop bleeding; if bleeding is caused when sewing the Cooper’s ligament or the vaginal wall, bipolar electrocoagulation should be used immediately to stop bleeding, in order to prevent the anatomical relationship from being unclear, resulting in bladder or urethra injuries; sometimes, hemorrhage is often required to be transferred to the open abdomen, therefore, when separating the retroperitoneal space, it is not possible to use bipolar electrocoagulation. Therefore, when separating the retropubic space, the pubic bone should not be too close to the pubic bone, so as not to injure the obturator vein. (2) Perforation of bladder or penetration of suture needle: firstly, it occurs when incising the posterior peritoneum, due to the confusion of recognizing the edge of the bladder, it is easy to incise the bladder; secondly, it is easy to occur when separating Retzius’ space and when the suture needle passes through the vaginal wall, for this reason, it can be filled up with methylene blue solution firstly, and if there is any injury, it can be repaired immediately under the laparoscopy. A urinary catheter is left in place for more than 7 days after surgery. (3) Urethral injury also occurs from time to time, such as penetrating injury, removal of stitches can be, such as transverse injury, it is necessary to open the urethral anastomosis, the urethral tube should be appropriately prolonged after the operation until the urethral anastomosis is completely healed, otherwise it is easy to occur urethral stenosis. (4) urethral obstruction: due to the suspension of the bladder neck angle is too large, there can be difficulty in urination, or urethral obstruction, some with the position. If urethral obstruction occurs, conservative treatment is needed, including urethral dilatation, changing the position of urination and drug relaxation of the bladder neck, etc. If it is ineffective, the sutures need to be removed and the bladder neck should be re-suspended until the obstruction is corrected. 2.5 Evaluation of the efficacy of surgical treatment of tension urinary incontinence, there are many surgical treatment methods, among which urethral sling surgery and Cooper’s ligament suspension surgery is more effective. Cooper’s ligament suspension surgery is to raise the position of the bladder neck and urethra, narrow the posterior angle of the urethrocystic bladder, increase the resistance of the bladder neck, so that the urethra is still long enough when the abdominal pressure is increased and the bladder neck can not be opened, thus enhancing the effect of controlling the overflow of urine. The cure rate of 3 months to 1 year after surgery is 71%～95%. Laparoscopic suburethral midurethral sling suspension is suitable for patients with intrinsic sphincter defects of tension incontinence, which are usually poorly treated with Burch suspension. The effectiveness of suburethral sling suspension is about 90%, and the results are stable over 6 years of follow-up. Laparoscopic suburethral suspension of the bladder neck and mid-urethra has certain advantages over transvaginal surgery, firstly, the trauma can be completely hemostatized, and secondly, the position of the sling can be accurately positioned, and laparoscopically-assisted vaginal hysterectomy and uterosacral ligament vaginal dome suspension can be used in the treatment of uterine prolapse in patients with varying degrees of uterine prolapse.