European journal of obstetrics, gynecology, and reproductive biology · 2026
The effect of temporary dual artery ligation (TDAL) during laparoscopic myomectomy on reducing intraoperative blood loss: a retrospective cohort study.
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Kang Jun-Hyeok, Seo Yumi, Lee Hyunji, Paik E Sun
Аннотация
OBJECTIVE: To introduce the temporary dual artery ligation (TDAL) technique and evaluate its. effectiveness in reducing intraoperative blood loss during laparoscopic myomectomy (LM).
METHODS: We retrospectively reviewed 178 patients: 83 in the TDAL group and 95 in the Non-TDAL group. Leiomyoma burden indexes (dominant size, sum of diameters, total weight, and volume), surgical outcomes (operation time and hemoglobin [Hb] change), and perioperative complications were compared. Multivariate regression and receiver operating characteristic (ROC) curve analyses were performed to identify the optimal leiomyoma burden thresholds where TDAL was most effective.
RESULTS: Total operative time was significantly longer in the TDAL group than in the Non-TDAL group (165.14 ± 53.08 vs. 144.21 ± 83.94 min, p = 0.036). However, the mean decrease in serum Hb level was significantly lower in the TDAL group (1.74 ± 0.92 vs. 2.08 ± 1.12 g/dL, p = 0.027). Multivariate analysis confirmed that TDAL was independently associated with a smaller perioperative Hb decline (β = -0.396, 95 % CI: -0.684 to -0.107, p = 0.007). Subgroup analyses using ROC-derived cut-off values revealed that TDAL significantly reduced blood loss in patients with a dominant leiomyoma ≥ 8 cm, a total sum of diameters ≥ 15 cm, or a resected weight ≥ 250 g.
CONCLUSION: TDAL during LM effectively reduces intraoperative blood loss, particularly in patients with a high leiomyoma burden.
METHODS: We retrospectively reviewed 178 patients: 83 in the TDAL group and 95 in the Non-TDAL group. Leiomyoma burden indexes (dominant size, sum of diameters, total weight, and volume), surgical outcomes (operation time and hemoglobin [Hb] change), and perioperative complications were compared. Multivariate regression and receiver operating characteristic (ROC) curve analyses were performed to identify the optimal leiomyoma burden thresholds where TDAL was most effective.
RESULTS: Total operative time was significantly longer in the TDAL group than in the Non-TDAL group (165.14 ± 53.08 vs. 144.21 ± 83.94 min, p = 0.036). However, the mean decrease in serum Hb level was significantly lower in the TDAL group (1.74 ± 0.92 vs. 2.08 ± 1.12 g/dL, p = 0.027). Multivariate analysis confirmed that TDAL was independently associated with a smaller perioperative Hb decline (β = -0.396, 95 % CI: -0.684 to -0.107, p = 0.007). Subgroup analyses using ROC-derived cut-off values revealed that TDAL significantly reduced blood loss in patients with a dominant leiomyoma ≥ 8 cm, a total sum of diameters ≥ 15 cm, or a resected weight ≥ 250 g.
CONCLUSION: TDAL during LM effectively reduces intraoperative blood loss, particularly in patients with a high leiomyoma burden.