LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY AS DEFINITIVE THERAPY FOR STAGE-III AND STAGE-IV ENDOMETRIOSIS

Operative laparoscopy combined with vaginal hysterectomy and salpingo- oophorectomy was used to treat advanced endometriosis in 40 of 46 pati ents. This treatment plan was abandoned in favor of laparotomy in six patients. Of the 40 patients successfully treated by laparoscopically assisted vaginal hysterectomy, 39 are completely free of symptoms. Maj or complications, including blood loss requiring transfusion and injur y to the ureter or bowel, were sustained at acceptable rates. No serio us infections occurred. The mean operating time was 191 minutes. Lapar oscopically assisted vaginal hysterectomy and removal of all ovarian t issue combined with excision of all endometriosis may be used as defin itive therapy for advanced endometriosis. The major complications asso ciated with surgical therapy for high-stage endometriosis are encounte red; therefore, laparoscopic treatment requires advanced laparoscopic surgical skills.