Temporary Uterine Tourniquet Application Versus Local Myometrial Epinephrine Injection During Laparoscopic Myomectomy

Exclusion Criteria

• •Patients with more than 3 myomas or any myoma larger than 10 cm.
• •Patients with suspected uterine malignancy (e.g., leiomyosarcoma).
• •Patients with known bleeding disorders or on anticoagulant therapy that cannot be safely discontinued.
• •Patients with significant cardiovascular disease, uncontrolled hypertension, or arrhythmias (relative contraindications for epinephrine).
• •Patients with active pelvic infection.
• •Patients with previous extensive uterine surgery (e.g., multiple prior myomectomies or extensive uterine reconstruction) that may compromise uterine integrity.
• •Patients undergoing concurrent major gynecological procedures that might significantly affect blood loss (e.g., hysterectomy, extensive adhesiolysis).
• •Patients with known allergy to epinephrine.
• •Patients unwilling or unable to comply with follow-up protocols.