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Comparative outcomes of abdominal, laparoscopic, and vaginal sacral colpopexy: A national analysis of apical suspension procedures (2014-2022)

Year: 2026

Type: article

Abstract: Objective: Sacral colpopexy is a well-established procedure for apical suspension, but the relative outcomes of abdominal, laparoscopic, and vaginal approaches remain debated. This study compared perioperative outcomes across these surgical routes using a national database and evaluated trends in robotic assistance. Materials and Methods: We analyzed sacral colpopexy cases from the American College of Surgeons National Surgical Quality Improvement Program between 2014 and 2022. Patient demographics, complication rates, and surgical outcomes were compared among abdominal, laparoscopic, and vaginal procedures. Relative risks (RR) were adjusted for confounders. The utilization of robotic systems in laparoscopic procedures was examined. Results: Among 61,524 cases, 3,497 (5.7%) were abdominal, 22,752 (37.0%) laparoscopic, and 35,275 (57.3%) vaginal. Vaginal procedures were more common in older patients, while laparoscopic approaches predominated among younger and higher-body mass index patients. Non-Hispanic White patients most often underwent vaginal surgery (60.5%), whereas African American patients most frequently underwent laparoscopic procedures (6.4%). Laparoscopic sacral colpopexy had the lowest complication rate (7.8%), with fewer superficial surgical site infections, transfusions, readmissions, and reoperations. Adjusted analysis showed a lower risk with laparoscopic surgery compared with abdominal surgery [RR: 0.75, 95% confidence interval (CI): 0.67-0.85]. Vaginal surgery showed no significant difference compared with abdominal surgery (RR: 1.09, 95% CI: 0.97-1.21). Robotic assistance increased markedly, comprising 73.5% of laparoscopic procedures in 2022. Conclusion: Laparoscopic sacral colpopexy, particularly with robotic assistance, is associated with fewer perioperative complications compared with abdominal and vaginal approaches. These findings support minimally invasive techniques as preferred approaches for apical suspension, and further research is needed on long-term outcomes and cost-effectiveness.

Source: Journal of Turkish Society of Obstetric and Gynecology

DOI: 10.4274/tjod.galenos.2026.76906

Authors: Smit Bharat Solanki, Apurva B. Pancholy, Vishal Pancholy

Institutions: Institute of Transplantation Sciences, The University of Texas Health Science Center at Houston, Texas A&M University

Language: English

Topic: Pelvic floor disorders treatments

Subfield: Rheumatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7126060834