Laparoscopic Lateral Suspension for Apical Pelvic Organ Prolapse: A Systematic Review of Current Evidence on Clinical Outcomes and Safety.

Objective: To summarize current evidence on the clinical outcomes and safety of laparoscopic lateral suspension (LLS) for apical pelvic organ prolapse and to distinguish direct comparative evidence from non-comparative outcome data. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidance. PubMed, Embase, Scopus, Web of Science, CENTRAL, clinical trial registries, grey literature sources, and reference lists were searched from inception to May 2025. Eligible studies included adult women with apical pelvic organ prolapse of stage 2 or higher who underwent LLS with or without mesh. Both comparative and non-comparative clinical studies were eligible if they reported anatomical outcomes, patient-reported outcomes, complications, reoperation, recurrence, or perioperative outcomes. Two reviewers independently screened records and extracted data. Because of heterogeneity in study design, surgical technique, comparator status, follow-up duration, and outcome definitions, findings were synthesized narratively and meta-analysis was not performed. Results: Thirteen studies were included: one randomized comparative study, four non-randomized surgical comparative studies, one quasi-experimental care-intervention study, and seven non-comparative observational studies. The available evidence suggested favorable apical and anterior anatomical outcomes after LLS, with reported apical success generally ranging from 87.3% to 100%. Patient-reported outcomes, including symptom improvement, satisfaction, quality of life, and sexual function, generally improved after surgery. Reported major complications and reoperations were uncommon, although safety outcomes were inconsistently defined and underpowered in several studies. Direct comparative evidence was limited and heterogeneous, and most studies were observational. Conclusion: Current evidence suggests that LLS may provide favorable anatomical and patient-reported outcomes for apical and anterior compartment prolapse, but certainty remains limited because of heterogeneous, mostly observational evidence. Further multicenter studies with standardized long-term outcomes are needed.