Origin-Level Uterine Artery Ligation in Laparoscopic Hysterectomy for Intraligamentary Myoma.

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.