Temporary Uterine Artery Clamping During Laparoscopic Myomectomy and Perioperative Hemoglobin Decline: A...

Background/Objectives: The aim of this study was to evaluate the adjusted association of temporary uterine artery clamping with the absolute and percentage decreases in hemoglobin during the perioperative period in women undergoing laparoscopic myomectomy, and to evaluate this association after multivariable adjustment for patient and leiomyoma characteristics. Methods: This single-center, retrospective, comparative observational study included 118 patients who underwent elective laparoscopic myomectomy for uterine leiomyomas between January 2021 and January 2026 (65 with temporary uterine artery clamping and 53 controls). The decision to perform clamping was based on the surgeon's intraoperative assessment. The primary outcome measures were defined as absolute hemoglobin drop and percentage hemoglobin drop. The adjusted association of clamping with these measures was examined using multivariable linear regression models simultaneously adjusting for age, body mass index (BMI), and tumor burden (evaluated as dominant diameter in Model 1 and specimen weight in Model 2), with baseline hemoglobin additionally adjusted in absolute decline models. Results: No significant differences were found between the two groups in terms of baseline clinical and leiomyoma characteristics (age, BMI, number of pregnancies, preoperative hemoglobin level, leiomyoma size, and weight) (all p > 0.05). Although the difference in postoperative hemoglobin levels did not reach statistical significance (9.59 ± 1.70 vs. 10.01 ± 1.45 g/dL; p = 0.153), both the absolute hemoglobin decline (controls vs. clamping: 2.20 ± 0.90 vs. 1.83 ± 0.88 g/dL; p = 0.027) and the percentage hemoglobin decline (controls vs. clamping: 18.84 ± 7.77% vs. 15.24 ± 6.61%; p = 0.008) were significantly lower in the clamping group. Evaluated as a composite safety outcome across all 134 surgical patients (transfusion or conversion to laparotomy), procedural safety events occurred in 18.5% (12/65) of controls compared with 5.8% (4/69) of clamping cases, demonstrating a statistically significant reduction in composite major surgical morbidity in the clamping cohort (Fisher's exact test p = 0.033; Relative Risk = 0.31, 95% CI: 0.11 to 0.92). In both the primary and sensitivity multivariable models, temporary uterine artery clamping demonstrated a significant adjusted association with lower values of approximately 0.38 g/dL in absolute hemoglobin decline (p = 0.015-0.016) and approximately 3.6 percentage points in percentage hemoglobin decline (p = 0.007-0.008). Furthermore, while the preoperative hemoglobin level was independently and positively associated with the absolute decrease in hemoglobin (p < 0.001 in both absolute decline models), age, BMI, leiomyoma size, and weight showed no independent association. Conclusions: Temporary uterine artery clamping demonstrated a significant multivariable adjusted association with a modestly attenuated perioperative hemoglobin decline during laparoscopic myomectomy. The finding that static postoperative hemoglobin levels alone did not differ significantly between groups underscores the importance of using dynamic hemoglobin parameters in the assessment of surgical blood loss. Although the retrospective design limits causal inferences, temporary uterine artery clamping appears to be a feasible surgical adjunct associated with reduced perioperative hemoglobin decline in experienced hands; however, prospective trials evaluating operative duration, clamping intervals, and long-term reproductive safety are warranted before broader clinical safety can be definitively established. Temporary uterine artery clamping demonstrated a significant multivariable adjusted association with a modest attenuation in perioperative hemoglobin decline (approximately 0.38 g/dL) during laparoscopic myomectomy, whereas static postoperative hemoglobin levels alone did not differ significantly between groups. Given the modest clinical magnitude of this difference, the lack of a significant difference in standalone transfusion rates, and the potential for residual confounding by indication in this retrospective cohort, temporary clamping should be considered a feasible adjunctive measure in experienced hands rather than a definitive routine intervention, and prospective randomized trials are warranted.