Advanced pelvic organ prolapse (POP) often requires apical suspension procedures to restore normal pelvic anatomy. Among the most established surgical techniques are laparoscopic sacrohysteropexy (LSH) and sacrospinous ligament fixation (SSLF). This study aimed to compare the biomechanical pull-out strength of LSH and SSLF using a standardized fresh cadaveric model.

The study was conducted during a cadaveric workshop organized by the National Urogynecology Association, the National Obstetrics and Gynecology Association, and a university-based tertiary referral hospital. Six fresh cadavers underwent either LSH or SSLF, with various anchoring techniques employed. A digital crane scale was used to measure the maximum load-at-failure for each procedure, serving as an indicator of pull-out strength.
LSH was performed by an experienced surgeon, with mesh secured to the anterior and posterior vaginal walls using 4-0 Prolene sutures. Fixation to the sacral promontory was achieved using either tackers or 2–4 Prolene sutures. SSLF was carried out using the Anchorsure system, with anchors placed into the right sacrospinous ligament approximately two fingerbreadths medial to the ischial spine. The initial anchor placement was performed by an expert and served as a reference for subsequent placements by trainees.
Meshes and anchoring devices were provided free of charge by manufacturers, who had no role in study design, execution, or data analysis.

The cadavers ranged in age from 74 to 87 years and had BMIs between 22.13 and 33.89 kg/m². All were multiparous with multiple comorbidities but no history of gynecologic surgery. SSLF demonstrated higher pull-out strength (25.3–52.5 N) (Fig 2) than LSH (12.6–13.7 N) (Fig. 1), suggesting superior anchoring capability of the sacrospinous ligament. SSLF using tackers yielded consistent values (44–47 N), whereas LSH results varied with the number and placement of sutures on the sacral promontory. Vaginal load measurements were relatively stable across all specimens, averaging 42.6 N. Initial procedures by expert surgeons produced the highest pull-out values, highlighting the role of surgical technique.

SSLF provided stronger and more consistent apical support than LSH in this cadaveric model, indicating its potential advantage in POP repair.

Despite anatomical variations, SSLF showed superior fixation strength. Further clinical research is warranted to validate these findings in live patients and to determine the most effective surgical approach for POP management.