Before standardized terminology: a historical and technical perspective on early Korean modified double-level...

Cervical cerclage has traditionally been described using named procedures such as the Shirodkar and McDonald techniques, whereas contemporary interpretation increasingly requires more precise operative descriptors, including suture number, vertical level, retained components, and support or sealing function. Before such terminology was standardized, three early Korean reports described a modified transvaginal cerclage technique combining two vertically separated retained sutures with an intervening fibrin-sealant component. The initial 2000 case series introduced this configuration in 15 high-risk patients, including cases considered for transabdominal cerclage or presenting with bulging membranes. Subsequent comparative studies in 2003 and 2004 evaluated the same technical lineage after failed prior transvaginal cerclage and against conventional transvaginal cerclage, respectively. This Perspective re-examines these reports using contemporary operative-geometry terminology. We argue that they are best understood as a coherent Korean technical lineage of proximal-first retained double-level transvaginal cerclage with sealing, rather than as nonspecific "modified" cerclage. Recognizing this configuration may clarify how surgical innovation can precede the terminology needed to classify it.