Laparoscopy-assisted vaginal hysterectomy.

Intraoperative laparoscopy was used to evaluate pelvic pathology in 46 patients who had been anesthetized for abdominal hysterectomy. Because traditional indicators--clinical history, pelvic examination, and ultrasound studies--suggested the presence of more serious pelvic pathology, these patients were considered poor candidates for vaginal hysterectomy. Laparoscopic findings, however, revealed that 42 of the 46 (91%) could undergo uncomplicated vaginal surgery (which they did). Laparoscopy-assisted hysterectomy is recommended as an additional method of investigation in order to improve diagnostic accuracy and minimize surgical risk while allowing more frequent selection of the vaginal approach to hysterectomy.