Revisiting the Preoperative Uterine Artery Embolization: A Comparison of the Intraoperative Uterine Artery Tourniquet Technique

This study aims to compare the hemostatic outcomes of preoperative uterine artery embolization (UAE) with the intraoperative uterine artery tourniquet method in patients undergoing myomectomy for uterine fibroids. The study was designed as a single-center, retrospective analysis. It included fifty-four patients aged 18 to 49 who underwent myomectomy between August 2020 and September 2024, with 27 patients allocated to the preoperative UAE group and 27 to the intraoperative uterine artery tourniquet group. Preoperative imaging was conducted using contrast-enhanced magnetic resonance imaging, and the same surgical team performed all surgeries. The UAE was performed using a temporary embolizing agent (gelatin sponge). In the tourniquet group, hemostasis was achieved with a temporary pericervical uterine artery tourniquet created by passing a pediatric Foley catheter through the broad ligament to form a pericervical loop, with periodic release. The following parameters were evaluated: uterine volume, myoma volume, operative time, blood loss, hemoglobin drop, drainage amount, length of hospital stay, and time taken to return to daily activities. There were no significant differences in demographic data or myoma characteristics between the two groups. However, the tourniquet group exhibited notably longer operative times ( p = 0.018), increased blood loss ( p < 0.001), larger drops in hemoglobin levels ( p < 0.001), higher drainage amounts ( p = 0.001), more extended hospital stays ( p = 0.002), and extended recovery times ( p < 0.001) compared to the embolization group. Preoperative UAE was found to be associated with shorter operative times, reduced intraoperative blood loss, and quicker recovery compared to the intraoperative tourniquet method. These findings indicate that UAE is an effective hemostatic option, especially for patients with larger uterine sizes and a higher risk of bleeding.