Despite evidence that the vaginal route of surgery is associated with fewer complications and faster recovery, most of hysterectomies are performed abdomi- nally. Diagnostic and operative laparoscopy leads to the increasing number of hysterectomies performed vaginal- ly, although the laparoscopy may lead to serious compli- cations. Study showes the decreasing share of laparosco- py during vaginal hysterectomy depending on the increasing experience with vaginal surgery. Material and methods: 624 consecutive women subjected to hysterectomy were indicated for vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy for be- nign gynecological findings. The procedures were perfor- med by the same surgical team experienced with laparo- scopy and vaginal route of hysterectomy. The mean age of the patients was 45,3 years (range 34–71 years). 57 were nulliparae. 437 patients were indicated for operation due to myomas, 118 for the uterine descent, 16 for adnexal cystic masses and 53 were „the others“. At the same time bilaterall adnexectomy were added to 474 patients. The operations for the stress urine incontinence were perfor- med in 31 cases (Kelly-Stoeckel 19 and Pereyra 12 respec- tively). Ovarian vessels were coagulated by bipolar coa- gulation during laparoscopy and uterine vessels were ligated by the vaginal route of surgery. Results: Uterus was extirpated electively abdominally in 18 patients after diagnostic laparoscopy (unfavourable localizated intraligamentous myoma, distended bowels after using Tractrium by anestesiologist). Hysterectomy by vaginal route was finished in 606 patients. The mean operative time was 75 min. (35–180) and the mean ope- rative time of the laparoscopical part of operation was 35 min. (15–45). The estimated blood loss was 300 ml (100–550). In 41 patients lysis of dense pelvic adhesions during laparoscopical part caused that the vaginal part of surgery was safe. 27 complications were encountered postoperativelly (8 cases of pelvic inflammatory disease treated postoperativelly with antibiotics, 3 injuries of urinary bladder were recognized and treated peroperati- velly and 1 case of stress urinary incontinence appeared 10 weeks after hysterectomy). Conclusion: There is possible different extent of operative laparoscopy to vaginal hysterectomy according to litera- ture. Nulliparity or uterine myomas are not the contrain- dications for vaginal hysterectomy. The main contribution of operative laparoscopy for vaginal hysterectomy con- sists in lysis of dense adhesions in pelvic area and in evaluating or operating of adnexal cystic masses. Other indications are debatable because of prolonging the ope- rative time and general risks of diagnostic and operative laparoscopy. The main contribution of laparoscopy for the purposes of vaginal hysterectomy remains the assessment and treat- ment of dense pelvic adhesions or adnexal pathology rather than the hysterectomy itself. Bipolar coagulation of ovarian vessels decreases the blood loss in cases of enucleation or morcellation myoma(s) during vaginal part of operation.

        Key words: hysterectomy, laparoscopy