Vasopressin as a hemostatic agent in laparoscopic myomectomy: a systemic review and meta-analysis of efficacy, safety and clinical outcomes

INTRODUCTION: Hemorrhage represents a significant complication during laparoscopic myomectomy, with transfusion requirements occurring in 5–40% of procedures. Vasopressin, a potent vasoconstrictor, has been employed for hemostasis in gynecologic surgery but evidence regarding its efficacy and safety for laparoscopic myomectomy has not been systematically synthesized. This systematic review and meta-analysis comprehensively evaluates vasopressin efficacy and safety for hemostasis during laparoscopic fibroid removal EVIDENCE ACQUISITION: Systematic search of PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and Scopus databases conducted until November 28, 2025, identified studies comparing vasopressin to control interventions during laparoscopic myomectomy. Randomized controlled trials and observational comparative studies reporting blood transfusion requirement, blood loss, or adverse events were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Cochrane RoB 2 and ROBINS-I tools. Random-effects meta-analysis calculated pooled odds ratios (OR) for transfusion and mean differences (MD) for blood loss. GRADE methodology assessed evidence certainty. Subgroup analyses evaluated effect modification by fibroid characteristics, study quality, and surgical approach EVIDENCE SYNTHESIS: Twelve studies (1,348 participants) met inclusion criteria. Pooled analysis of seven studies demonstrated vasopressin reduced blood transfusion requirement by 72% compared to control (OR 0.28, 95% CI: 0.13–0.61, P = 0.002; number needed to treat = 8, 95% CI: 5–20). Eight studies showed vasopressin reduced intraoperative blood loss by approximately 122 mL (MD -122.45 mL, 95% CI: -204.31 to -40.58, P = 0.004; I²=78%). Six studies demonstrated hemoglobin preservation with vasopressin (1.23 g/dL greater than control, P < 0.0001). Safety analysis of 10 studies identified hypertension as the most common adverse event (3.9% vasopressin vs. 0.5% control), predominantly mild, self-resolving within 15–25 minutes. No deaths or permanent complications attributable to vasopressin were documented. Subgroup analyses revealed greatest benefit in large fibroids (> 8 cm; number needed to treat = 3) and multiple fibroids (number needed to treat = 3). Effect remained robust when high-risk studies were excluded (OR 0.22), suggesting findings not driven by bias. Trim-and-fill adjustment for publication bias yielded adjusted OR 0.54 (95% CI: 0.31–0.95), maintaining statistical significance. Evidence quality: GRADE moderate certainty for transfusion outcome, moderate for hemoglobin, low for blood loss due to high heterogeneity reflecting measurement methodology variation CONCLUSIONS: This meta-analysis demonstrates substantial hemostatic efficacy of vasopressin for laparoscopic myomectomy, reducing transfusion requirement by 72% and blood loss by approximately 120 mL, with a favorable safety profile when dilute formulations are employed. Vasopressin use should be considered a standard hemostatic adjunct during laparoscopic myomectomy, particularly in women with large or multiple fibroids at heightened hemorrhage risk. Future research should establish optimal vasopressin dosing protocols, investigate long-term pregnancy outcomes, and compare vasopressin efficacy across different surgical populations.