# Mid-term outcomes of laparoscopic vaginal stump-round (Kakinuma method) and stump-uterosacral (Shull method) ligament fixation for pelvic organ prolapse: A retrospective comparative study

## TL;DR

This study compares two laparoscopic surgical methods for treating pelvic organ prolapse and finds that the Kakinuma method is faster, less bloody, and has fewer recurrences than the Shull method.

## Contribution

The Kakinuma method is introduced as a novel native tissue repair technique for pelvic organ prolapse with improved outcomes compared to the Shull method.

## Key findings

- The Kakinuma method had significantly shorter operative duration and less blood loss compared to the Shull method.
- Recurrence rates were significantly lower in the Kakinuma group (5.3%) compared to the Shull group (15.0%).
- No perioperative complications were observed in either group.

## Abstract

Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) using mesh are popular approaches for treating pelvic organ prolapse (POP). However, it is not uncommon that native tissue repair (NTR) should be presented as an option to patients who are expected to have extensive intraperitoneal adhesion or patients for whom LSC or RSC is difficult owing to various risk factors. Laparoscopic vaginal stump–uterosacral ligament fixation (Shull method) has been introduced as a method for NTR in case of POP. However, effective repair using this surgical procedure may not be possible in severe POPs. To solve the problems of the Shull method, we devised the laparoscopic vaginal stump–round ligament fixation (Kakinuma method) in which the vaginal stump is fixed to the uterine round ligament, a histologically strong tissue positioned anatomically higher than the uterosacral ligament. This study aimed to retrospectively and clinically compare the two methods.

Of the 78 patients who underwent surgery for POP between January 2017 and June 2022 and postoperative follow-up for at least a year, 40 patients who underwent the Shull method (Shull group) and 38 who underwent the Kakinuma method (Kakinuma group) were retrospectively analyzed.

No significant differences were observed between the two groups in patient background variables such as mean age, parity, body mass index, and POP-Q stage. The mean operative duration and mean blood loss in the Shull group were 140.5 ± 31.7 min and 91.3 ± 96.3 ml, respectively, whereas the respective values in the Kakinuma group were 112.2 ± 25.3 min and 31.4 ± 47.7 ml, respectively. Thus, compared with the Shull group, the operative duration was significantly shorter (P < 0.001) and blood loss was significantly less (P = 0.003) in the Kakinuma group. Recurrence was observed in six patients (15.0%) in the Shull group and two patients (5.3%) in the Kakinuma group. Hence, compared with the Shull group, recurrence was significantly less in the Kakinuma group (P = 0.015). No patients experienced perioperative complications in either group.

The results suggest that the Kakinuma method can serve as a novel and viable NTR procedure for POP.