Haemostatic Effects and Systemic Implications of Intra-Myometrial Vasopressin in Laparoscopic Gynaecological Surgery

Background: Vasopressin is frequently employed to decrease blood loss through local vasoconstriction during laparoscopic gynaecological procedures. However, systemic absorption can lead to major problems, especially after an accidental intravascular injection.
Objectives: This review aims to evaluate the haemostatic efficacy, systemic effects and safety concerns of intra-myometrial vasopressin in gynaecological surgery. The risks/benefits of vasopressin are also compared with alternative pharmacological agents used for the control of intraoperative bleeding.
Methods:  This review was carried out in compliance with PRISMA principles. The literature published in PubMed and Google Scholar from 2000 to April 2025 was searched using the keywords vasopressin, haemostatic effects, cardiovascular effects, haemodynamics, systemic implications, safety measures and laparoscopic gynaecological surgery. The pharmacology, advantages, and cardiovascular and pulmonary side effects of intra-myometrial vasopressin in laparoscopic gynaecological surgery are reviewed and summarised. Non-laparoscopic gynaecological procedures, non-English literature, and animal research were excluded.
Results: Twenty studies, including case reports, cohort studies, and randomised controlled trials, met the requirements for inclusion. Bradycardia, transitory hypertension, arrhythmias, pulmonary oedema, and cardiac arrest were among the systemic effects that were reported. When compared to undiluted vasopressin, diluted vasopressin (0.05-0.1 units/mL) was linked to fewer systemic effects. Safe injection technique under direct visualization, dose limitation, and vigilant intraoperative monitoring were reported as key safety strategies.
Conclusions: While vasopressin effectively reduces intraoperative bleeding in laparoscopic gynaecological surgery, its systemic implications warrant caution. Adherence to safe practices, especially dilution of vasopressin and safe techniques of injection, has the potential to minimize life-threatening complications.