Comparative Outcomes of Abdominal, Laparoscopic, and Vaginal Sacral Colpopexy: A National Analysis of Apical Suspension Procedures (2014–2022)

Objectives
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.
Methods
We analyzed sacral colpopexy cases from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) 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. Robotic utilization 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-BMI patients. Non-Hispanic White patients most often underwent vaginal surgery (60.5%), whereas African American patients more frequently had 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 for laparoscopic compared with abdominal surgery (RR 0.75, 95% CI: 0.67–0.85). Vaginal surgery showed no significant difference versus abdominal (RR 1.09, 95% CI: 0.97–1.21). Robotic assistance increased markedly, comprising 73.5% of laparoscopic procedures in 2022.
Conclusions
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 strategies for apical suspension, with future research needed on long-term outcomes and cost-effectiveness.
Keywords: sacral colpopexy; laparoscopic surgery; robotic surgery; apical suspension; pelvic organ prolapse; surgical outcomes