JSLS : Journal of the Society of Laparoendoscopic Surgeons · 2026
Origin-Level Uterine Artery Ligation in Laparoscopic Hysterectomy for Intraligamentary Myoma.
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Dağlı Uğurcan, Kantarcı Sercan, Karabulut Alaattin, Yıldırım Fatih, Başpınar Anıl, Budak Adnan, İleri Alper, İnan Abdurrahman Hamdi
Аннотация
BACKGROUND AND OBJECTIVES: Intraligamentary myomas distort broad-ligament anatomy and carry a high risk of bleeding during hysterectomy. We examined whether concomitant origin-level uterine artery ligation was associated with lower estimated blood loss.
METHODS: In this retrospective single-center cohort, 170 consecutive women underwent total laparoscopic hysterectomy for intraligamentary myoma (2015-2025); 91 received bilateral origin-level ligation. Estimated blood loss was compared with a multivariable regression model adjusted for patient characteristics, myoma diameter, and lateral localization.
RESULTS: Myomas in the ligation group were larger (median 9 vs 7 centimeters) and more often lateral (48% vs 14%), whereas crude mean blood loss was similar. In the regression analysis of mean blood loss, ligation was associated with lower blood loss only after adjustment (adjusted mean ratio 0.84; 95% confidence interval, 0.78 to 0.89), corresponding to an adjusted absolute reduction of 18 milliliters (95% confidence interval, 11 to 25). The postoperative hemoglobin decrease was smaller in the ligation group; operative time, hospital stay, transfusion, and complications did not differ significantly (few events).
CONCLUSION: In this nonrandomized cohort, origin-level ligation was associated with a modest reduction in adjusted estimated blood loss, without a detectable increase in operative time. Because it was selected intraoperatively for larger, more complex myomas, confounding by indication cannot be excluded; the findings are hypothesis-generating rather than causal.
METHODS: In this retrospective single-center cohort, 170 consecutive women underwent total laparoscopic hysterectomy for intraligamentary myoma (2015-2025); 91 received bilateral origin-level ligation. Estimated blood loss was compared with a multivariable regression model adjusted for patient characteristics, myoma diameter, and lateral localization.
RESULTS: Myomas in the ligation group were larger (median 9 vs 7 centimeters) and more often lateral (48% vs 14%), whereas crude mean blood loss was similar. In the regression analysis of mean blood loss, ligation was associated with lower blood loss only after adjustment (adjusted mean ratio 0.84; 95% confidence interval, 0.78 to 0.89), corresponding to an adjusted absolute reduction of 18 milliliters (95% confidence interval, 11 to 25). The postoperative hemoglobin decrease was smaller in the ligation group; operative time, hospital stay, transfusion, and complications did not differ significantly (few events).
CONCLUSION: In this nonrandomized cohort, origin-level ligation was associated with a modest reduction in adjusted estimated blood loss, without a detectable increase in operative time. Because it was selected intraoperatively for larger, more complex myomas, confounding by indication cannot be excluded; the findings are hypothesis-generating rather than causal.