The effect of temporary dual artery ligation (TDAL) during laparoscopic myomectomy on reducing intraoperative blood loss: a retrospective cohort study.

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.