Laparoscopic sacrocolpopexy is the gold standard for the management of apical prolapse, providing excellent anatomical and functional outcomes. Traditionally performed under inpatient care, advances in minimally invasive surgery and enhanced recovery protocols have enabled its transition to an ambulatory setting. However, real-world data on its implementation remain limited.

To assess the safety and feasibility of laparoscopic sacrocolpopexy performed in an ambulatory setting, and to compare perioperative outcomes with conventional inpatient management.

A retrospective observational study was conducted including all consecutive patients undergoing laparoscopic sacrocolpopexy over a one-year period at a tertiary referral centre. Patients were stratified according to care setting: ambulatory versus inpatient. Baseline characteristics, surgical history, prolapse stage, estimated blood loss, operative time, operating room time (entry to exit), total hospital stay, and 30-day complications (Clavien–Dindo) were recorded, as well as readmissions. Cases initially scheduled for ambulatory surgery but requiring admission were specifically analysed.

A total of 20 patients were included: 15 underwent ambulatory surgery and 5 inpatient surgery, of whom 2 were initially scheduled for ambulatory management but required admission due to intraoperative or anaesthetic events. The ambulatory pathway success rate was 88.2% (15/17).
Median operative time was comparable between groups (145 vs 140 minutes). In the ambulatory group, median operating room time was 183 minutes (IQR 168.5–207.5), and median total hospital stay was 542 minutes (approximately 9 hours; IQR 479–596.5). In the inpatient group, median length of stay was 1 day (IQR 1–4), with one prolonged admission of 7 days.
No readmissions were observed. In the ambulatory group, complications occurred in 3/15 patients (26.7%), all Clavien–Dindo grade II. In the inpatient group, three intraoperative events were recorded according to the ICARUS classification, including mesenteric bleeding, bladder injury and intraoperative desaturation.

This study shows that laparoscopic sacrocolpopexy can be successfully transitioned to an ambulatory setting without compromising surgical performance or short-term safety. Operative times were comparable between ambulatory and inpatient cases, suggesting that case complexity was not significantly different.
The high success rate of the ambulatory pathway (88.2%) supports the feasibility of same-day discharge in appropriately selected patients. Importantly, no readmissions were observed, reinforcing the safety of this approach.
Complications in the ambulatory group were limited to Clavien–Dindo grade II events, while intraoperative events requiring admission were appropriately managed within the inpatient pathway. This highlights the importance of careful patient selection and flexible perioperative decision-making.
Overall, these findings reflect a safe and effective implementation of an ambulatory pathway in real-world clinical practice.

Laparoscopic sacrocolpopexy can be safely implemented in an ambulatory setting in selected patients, with comparable operative times and a marked reduction in hospital stay, without increasing short-term morbidity. These findings support its adoption as part of enhanced recovery pathways in pelvic reconstructive surgery.