Laparoscopic and vaginal colpotomy for the excision of infiltrating cul-de-sac endometriosis.

Palpable endometriotic nodules deep in the cul-de-sac and vagina represent the extension of intraperitoneal disease. Although such nodules used to be excised with vaginal colpotomy and by tracing the endometriosis to the peritoneum, the dissection of these lesions under laparoscopic visualization had aided in their removal. Of seven patients who were approached with a plan for combined laparoscopic and vaginal excision, five underwent the procedure. The last two required laparotomy due to bowel muscularis involvement.