Miya Hook Ligature Carrier
The Miya Hook is a reusable ligature carrier described by Frank S. Miyazaki in 1987 for transvaginal sacrospinous ligament fixation (SSLF). The described technique guides the hook by palpation through the coccygeus–sacrospinous complex. Historical clinical series and cadaver studies describe Miya Hook use in SSLF.[1][2][3]
Design
- Long curved metal shaft matching the sacrospinous-ligament approach angle
- Hook-shaped distal end with eye for suture engagement
- Reusable. Follow the specific model's processing instructions
- No power source or integrated capture mechanism. Operator-driven mechanic
Miyazaki described the close anatomical relationship of the coccygeus muscle and sacrospinous ligament; later techniques still require attention to the adjacent neurovascular structures.[1]
Technique
Original Miyazaki Technique
- Thread suture through the hook eye.
- Advance the hook into the paravaginal space under two-finger palpation; tip onto the sacrospinous ligament approximately two fingerbreadths medial to the ischial spine. This landmark does not guarantee vascular clearance, as Manning and Arnold observed in cadavers.[6]
- Drive the hook through the ligament complex and back out.
- Disengage suture on the far side; retrieve.
- Withdraw the hook, leaving the suture through the ligament.
Mattox 1995 Modification
Mattox and colleagues modified the technique to pass the hook unloaded first, then back-thread the hook with suture and withdraw. Reported faster, fewer instruments required, no suture fraying, no complications in > 50 patients.[2]
Clinical Evidence
| Series | Design | Key Result |
|---|---|---|
| Miyazaki 1987 original | 74 procedures over 24 mo, chiefly performed by residents in training | No hemorrhages, no nerve injury, no rectal injury[1] |
| Hardiman & Drutz 1996 | 130 attempted vault suspensions; 125 completed (5 abandoned for technical difficulty); 6 mo–5 yr follow-up | Recurrent vault prolapse 2.4% and febrile morbidity 10% in a procedure series with concomitant operations[3] |
| Pollak 2007 comparative | Retrospective 240 pts — direct-vision needle driver (n=46) vs Deschamps (n=173) vs Miya Hook (n=21) | No significant difference in intraoperative complications across the three; Deschamps had significantly higher postoperative complications vs direct-vision (18% vs 2%, p=0.002)[4] |
Biomechanical Pull-Out — Cadaveric Samples
Lo 2026 measured pull-out forces in eight cadavers. Anchorsure fixation was tested on the right sacrospinous ligament of six cadavers, and Miya Hook fixation and uterosacral ligament suspension bilaterally in the other two; uterosacral suspension had the highest mean load at failure (81.4 ± 5.5 N).[5]
| Device | Mean load at failure |
|---|---|
| SSLF with Miya Hook | 69.2 ± 5.9 N |
| SSLF with Anchorsure | 44.0 ± 15.9 N |
The study discusses tissue engagement as a possible explanation.[5]
Vascular Safety — Manning 2014 Intermediate Position
In Manning 2014's cadaveric thin-ligament model, the Miya Hook impinged but deflected vessels behind the ligament.[6]
| Safety class | Devices |
|---|---|
| Remained within ligament in this model | Capio, Caspari, Endostitch |
| Impinged but deflected vessels in this model | Miya Hook, Deschamps |
| Penetrated coccygeal branches in this model | i-Stitch |
Advantages and Limitations
| Dimension | Detail |
|---|---|
| Cost | Reusable; actual costs depend on instrument and processing |
| Biomechanical fixation | 69.2 N mean in two cadavers in Lo 2026[5] |
| Clinical track record | Historical procedure series, including Miyazaki, Hardiman and Pollak[1][3][4] |
| Cadaveric vessel trajectory | Impinged but deflected vessels in Manning's thin-ligament model[6] |
| Visualization | Palpation-guided only; no direct visualization |
| Dissection required | Depends on approach and exposure; no quantified comparative measure here |
| Resource setting | Reusability may be useful where supply cost constrains options[6] |
Position in the SSLF Device Family
| Device | Mechanism | What the cited evidence actually measures |
|---|---|---|
| Miya Hook | Palpation-guided carrier | 69.2 ± 5.9 N in two cadavers in Lo; vessel deflection in Manning cadavers[5][6] |
| Deschamps ligature carrier | Curved carrier | Vessel deflection in Manning cadavers[6] |
| Capio, Endostitch | Suture capture | Remained within ligament in Manning cadavers[6] |
| Anchorsure | Permanent anchor | 44.0 ± 15.9 N in six different cadavers in Lo[5]; a separate retrospective mixed-device cohort (676 patients, 19 Anchorsure alone) reported 2.2% tacker dislodgement but classified 27/676 patients (4.0%) as having dislodgement. The discrepancy is unresolved[8] |
| Saffron | Permanent anchor | 17.9 ± 5.6 N in a separate three-cadaver study[9] |
| i-Stitch | Suture capture | Coccygeal-branch penetration in Manning cadavers[6] |
Bottom Line
The Miya Hook occupies an important historical and practical niche:
- A historically important reusable SSLF carrier with published procedure series.[1][3]
- Lo's cadaveric loads differed between Miya and Anchorsure samples, but were measured in different cadavers.[5]
- In Manning's cadaver comparison, the Miya Hook impinged on but deflected vessels behind thin ligaments.[6]
Amiri 2024's pooled adverse-event results are across techniques.[7]
See also: Deschamps Ligature Carrier, Capio Suture Capturing Device, Endostitch, i-Stitch, Anchorsure System, Saffron Fixation System, Bony Pelvic Anatomy, Pelvic Vascular Anatomy.
References
1. Miyazaki FS. "Miya hook ligature carrier for sacrospinous ligament suspension." Obstet Gynecol. 1987;70(2):286–8. PMID 3601293
2. Mattox TF, Kelly T, Bhatia NN. "Modification of the Miya hook in vaginal colpopexy." J Reprod Med. 1995;40(10):681–3. PMID 8551466
3. Hardiman PJ, Drutz HP. "Sacrospinous vault suspension and abdominal colposacropexy: success rates and complications." Am J Obstet Gynecol. 1996;175(3 Pt 1):612–6. doi:10.1053/ob.1996.v175.a74410
4. Pollak J, Takacs P, Medina C. "Complications of three sacrospinous ligament fixation techniques." Int J Gynaecol Obstet. 2007;99(1):18–22. doi:10.1016/j.ijgo.2007.04.028
5. Lo TS, Li CW, Ro AL, et al. "Pullout testing for sacrospinous ligament and uterosacral ligament in apical suspension: a cadaveric biomechanical study." Int J Gynaecol Obstet. 2026;175(1):388–395. doi:10.1002/ijgo.71036
6. Manning JA, Arnold P. "A review of six sacrospinous suture devices." Aust N Z J Obstet Gynaecol. 2014;54(6):558–63. doi:10.1111/ajo.12272
7. Amiri E, Bastani P, Mallah F, Mostafaei H, Salehi-Pourmehr H. "Comparison of the complications rate of different suture-passing techniques at the time of sacrospinous ligament fixation: a systematic review and meta-analysis." Arch Gynecol Obstet. 2024;310(6):2791–2809. doi:10.1007/s00404-024-07788-5
8. Lo TS, Rellora LE, Yu CC, et al. "Operator and Patient Injuries From Tacker Dislodgement During Sacrospinous Ligament Fixation: A Retrospective Study." BJOG. 2026;133(4):716–724. doi:10.1111/1471-0528.70089
9. van Raalte H, Bhatia N, Mangel J, Ryckebusch H, Roovers JP. "A novel anchoring system for pelvic organ prolapse repair: an observational study." Int Urogynecol J. 2023;34(7):1593–1598. doi:10.1007/s00192-022-05444-7