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).