Abstract
Background: Laparoscopic sacropexy (SP) is widely recognized as the gold standard for addressing apical pelvic organ prolapse. Nonetheless, alternative laparoscopic procedures, such as pectopexy (PP) and Dubuisson's laparoscopic lateral suspension (LLS), have gained traction due to their relative technical simplicity. Objective: This study aims to assess both the preoperative characteristics and surgical outcomes in a cohort-based comparative study of three minimally invasive apical prolapse surgeries. Methods: We conducted a prospective, single-center study involving patients treated laparoscopically for apical prolapse. The surgical approaches compared include: sacropexy (SP); laparoscopic lateral suspension following Dubuisson's technique (LLS), and pectopexy (PP). Results: A total of 180 patients underwent surgery: 115 with SP, 33 with LLS, and 32 with PP. While some differences were observed in patient profiles-such as a lower average BMI and more advanced prolapse stages (III and IV) in the SP group-the rates of surgical failure (evaluated through apical recurrence, need for reintervention, pessary use, and persistent symptoms) did not differ statistically between groups. In terms of anatomical outcomes, only the total vaginal length (TVL) was notably longer in the SP group. A clinically important finding was the substantially reduced operative time with the alternative methods, particularly LLS, which took less than half the duration required for SP, without any increase in intraoperative complication rates. Conclusions: Further research, particularly well-designed randomized multicenter trials, is essential to establish the relative efficacy of the alternative approaches (LLS and PP) compared with the current gold standard, sacropexy.