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Published on: September 12, 2025
Origin-Level Uterine Artery Ligation in Laparoscopic Hysterectomy for Intraligamentary Myoma
Uğurcan Dağlı1, Sercan Kantarcı1, Alaattin Karabulut1
1Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey. (Drs. Dağlı, Kantarcı, Karabulut, Yıldırım, Budak, İleri, and İnan).
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.
