Evaluation of the effects of tourniquet, uterine artery bulldog clamp, and non-compressure techniques on bleeding and hemogram during open myomectomy in uterine leiomyomas

ABSTRACT Evaluation of the Effects of Tourniquet, Uterine Artery Bulldog Clamp, and Non-Compression Techniques on Bleeding and Hemogram During Open Myomectomy for Uterine Leiomyomas Objective: The aim of this study was to compare the effects of different uterine artery compression techniques applied during myomectomy (tourniquet, bulldog clamp, and no compression) on intraoperative blood loss and postoperative hematological parameters. Materials and Methods: This prospective, randomized, and controlled clinical study included a total of 120 women aged 18–45 years who were scheduled for myomectomy and had intramural or subserosal fibroids classified as FIGO types 3–6. Patients were randomly allocated into three equal groups using a computer-based block randomization method: uterine artery tourniquet group (n=40), bulldog clamp group (n=40), and non-compression myomectomy group (n=40). Hematological parameters were evaluated preoperatively and on postoperative days 1 and 2. Operative time and intraoperative blood loss were recorded. Data were analyzed using appropriate statistical methods, and factors affecting blood loss were investigated using multiple linear regression analysis. Results: No statistically significant differences were observed among the groups in terms of age, body mass index, number of fibroids, or FIGO fibroid type (all p>0.05). Preoperative hemoglobin and hematocrit levels were comparable between the groups (p=0.621 and p=0.913, respectively). On postoperative day 1, hemoglobin levels were 11.1±1.3 g/dL in the tourniquet group, 11.8±1.6 g/dL in the clamp group, and 10.5±1.5 g/dL in the non-compression group, showing a statistically significant difference among the groups (p<0.001). Hematocrit levels on the same day were 33.0±3.9%, 34.9±4.3%, and 31.5±4.1%, respectively, and also differed significantly (p=0.004). On postoperative day 2, hemoglobin levels were 10.3±1.4 g/dL, 11.4±1.4 g/dL, and 9.8±1.5 g/dL in the tourniquet, clamp, and non-compression groups, respectively (p<0.001). Corresponding hematocrit values were 30.4±4.2%, 33.2±3.4%, and 29.5±3.6%, with a significant difference among groups (p<0.001). No significant differences were observed in postoperative platelet counts (p>0.05). Intraoperative blood loss was 248.8±60.4 mL in the tourniquet group, 240.0±86.4 mL in the clamp group, and 295.0±73.2 mL in the non-compression group, with a statistically significant difference among the groups (p=0.002). Operative time did not differ significantly between the groups (p=0.891). Multiple linear regression analysis demonstrated that surgical group (B=22.129, p=0.011) and operative time (B=1.762, p=0.008) were independent predictors of intraoperative blood loss. Conclusion: The application of uterine artery tourniquet or bulldog clamp during myomectomy significantly reduces intraoperative blood loss and limits postoperative decreases in hemoglobin and hematocrit levels compared with non-compression myomectomy. These techniques appear to be safe and effective blood loss control strategies in appropriately selected patients. Key Words: Hemoglobin, Randomized Controlled Trial, Intraoperative Hemorrhage, Myomectomy, Uterine Artery Occlusion.