The Effect of Temporary Uterine Artery Ligation on Blood Loss During Laparoscopic Myomectomy: A Systematic Review and Meta-Analysis

Abstract Introduction: The effectiveness of temporary uterine artery ligation (TUAL) in reducing blood loss during laparoscopic myomectomy (LM) is uncertain, despite increased use as an adjunct to improve surgical safety. This study aims to evaluate the safety and efficacy of TUAL in LM for the management of uterine myomas. Material and methods: We conducted a systematic review and meta-analysis of comparative studies evaluating LM with and without TUAL. Electronic databases were searched up to October 7, 2024. Eligible studies were randomized controlled trials or observational comparative studies published in English that reported at least one primary outcome. The primary outcomes were intraoperative estimated blood loss and perioperative change in hemoglobin. Secondary outcomes included operative time, number and size of myomas removed, length of hospital stay, recurrence, and complication rates. Data extraction and analysis were performed using a random-effects model. This review was registered prospectively with PROSPERO (CRD42024595684). Results: Seven studies met the inclusion criteria, comprising five randomized controlled trials and two retrospective case-control studies, with a total of 857 women (352 undergoing LM with TUAL and 505 undergoing LM alone). TUAL was associated with a reduction in intraoperative estimated blood loss (MD: -84.7 mL; 95% Cl: -89.0; -80.0) and postoperative reduction in hemoglobin level (MD: -0.4 g/dL; 95% Cl: -0.7; -0.2) compared with LM without TUAL. However, TUAL was associated with increased operative time (MD: 16.5 min; 95% Cl: 3.4; 29.6). Conclusions: TUAL appears to be a possible adjunct to LM for selected patients in the management of uterine myomas. Our study demonstrated that TUAL with LM could be associated with a reduction in estimated blood loss, despite an increase in operative time. Nonetheless, further studies with a larger sample size and long-term follow-up, as well as stratification of outcomes based on ligation technique, are warranted to elucidate the benefits of TUAL.