Inoue H, et al. – The goal of this study is to clarify the usefulness of tissue fixation system (TFS) by evaluating 5–year postoperative outcomes. Reinforcing up to four ligaments with the TFS was adequate for the cure of third– and fourth–degree pelvic organ prolapse (POP). The technique is minimally invasive, appropriate for elderly women, and effective at 5 years for both anatomical and symptom cure.