Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2023; 11(15): 3457-3463
Published online May 26, 2023. doi: 10.12998/wjcc.v11.i15.3457
New native tissue repair for pelvic organ prolapse: Medium-term outcomes of laparoscopic vaginal stump–round ligament fixation
Toshiyuki Kakinuma, Ayaka Kaneko, Kaoru Kakinuma, Ken Imai, Nobuhiro Takeshima, Michitaka Ohwada
Toshiyuki Kakinuma, Ayaka Kaneko, Kaoru Kakinuma, Ken Imai, Nobuhiro Takeshima, Michitaka Ohwada, Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
Author contributions: Kakinuma T contributed to methodology, software, validation, formal analysis, writing-original draft preparation, writing-review and editing, visualization, supervision, and project administration; Kakinuma T, Kakinuma K, Kaneko A, Imai K, Takeshima N, and Ohwada M collected data and performed the research; All authors contributed to investigation, resources, data curation, and read and agreed to the published version.
Institutional review board statement: The study was approved by the Ethics Committee of the International University of Health and Welfare Hospital, No. 21-B-463.
Informed consent statement: All patients provided written and oral informed consent for the procedure and study participation after a proper explanation of the risks and benefits of the surgical procedure.
Conflict-of-interest statement: All authors report having no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this article and its supplementary material files. Further inquiries can be directed to the corresponding author at tokakinuma@gmail.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toshiyuki Kakinuma, MD, PhD, Doctor, Professor, Department of Obstetrics and Gynecology, International University of Health and Welfare, 537-3, Iguchi, Nasushiobara 329-2763, Japan. tokakinuma@gmail.com
Received: January 9, 2023
Peer-review started: January 9, 2023
First decision: February 2, 2023
Revised: March 2, 2023
Accepted: April 14, 2023
Article in press: April 14, 2023
Published online: May 26, 2023
ARTICLE HIGHLIGHTS
Research background

Laparoscopic sacrocolpopexy for pelvic organ prolapse (POP) had been gaining popularity as a new approach. However, since the United States Food and Drug Administration alert against the use of mesh, native tissue repair (NTR) using the patient’s own tissue without mesh has gained attention.

Research motivation

Vaginal stump sacral uterine ligament fixation (Shull method) is a feasible surgical procedure for NTR with good results. However, in severe POP, the length of the vaginal canal and overstretching of the sacral uterine ligament may prevent effective repair by simply fixing the vaginal stump and sacral uterine ligament.

Research objectives

To solve this problem, an operation to fix the vaginal stump to the round ligament, which is a histologically tough tissue that is anatomically higher than the sacral uterine ligament, is performed laparoscopically; thus, inferior vaginal stump–round ligament fixation (the Kakinuma method) was devised. This study aimed to investigate the efficacy and safety of the Kakinuma method in POP.

Research methods

From January 2020 to December 2021, 30 patients who underwent the Kakinuma method for POP were examined, and the operative time, bleeding amount, recurrence rate, etc were investigated.

Research results

The average age was 66.5 ± 9.1 years, the number of deliveries was 2.5 ± 0.6, body mass index was 24.5 ± 3.3, and the POP quantification stage classification was stage II in 8 cases, stage III in 11, and stage IV in 11. The average operating time was 113.4 ± 22.6 min, the average blood loss was 26.5 ± 39.7 mL, there were no perioperative complications, and no cases of POP recurrence were observed.

Research conclusions

The Kakinuma method in POP could be a safe and effective treatment similar to conventional NTR.

Research perspectives

Future studies including more patients should examine outcomes such as recurrence rate, recurrence time, and POP quantification stages in recurrent cases. We are currently comparing the Kakinuma method with other NTR-based repair strategies for patients with moderate-to-severe POP.