Operative laparoscopy combined with vaginal hysterectomy and salpingo-oophorectomy was used to treat advanced endometriosis in 40 of 46 patients. 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. Major complications, including blood loss requiring transfusion and injury to the ureter or bowel, were sustained at acceptable rates. No serious infections occurred. The mean operating time was 191 minutes. Laparoscopically assisted vaginal hysterectomy and removal of all ovarian tissue combined with excision of all endometriosis may be used as definitive therapy for advanced endometriosis. The major complications associated with surgical therapy for high-stage endometriosis are encountered; therefore, laparoscopic treatment requires advanced laparoscopic surgical skills.