A vaginal hysterectomy is a reasonable surgical choice for carefully selected patients. The standard approach still requires total hysterectomy and removal of the ovaries. For women who are very large or who have significant medical illnesses, a vaginal approach can minimize the risk of postoperative complications.
When a vaginal approach is combined with laparoscopy, one can ensure a full surgical evaluation for endometrial cancer, but vaginal approaches by themselves should be restricted to women at risk from surgery and who have early-stage endometrial cancers. This is because the lymph nodes can’t be removed at the time of a vaginal surgery.
A vaginal only approach is very limiting because it does not allow the surgeon to survey the abdomen and pelvis. In addition, not all gynecologists can remove ovaries through the vagina. The addition of the laparoscope allows both survey of the abdomen and removal of the ovaries.