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

Inclusion Criteria: * Female patients aged 18-45 years. * Diagnosed with symptomatic uterine leiomyomas requiring laparoscopic myomectomy. * Presence of at least one myoma with a diameter ≥3 cm and ≤10 cm. * Patients with up to 3 myomas (to standardize surgical complexity). * Preoperative hemoglobin level ≥10 g/dL. * Ability to provide informed consent. 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.