Objective The purpose of this study was to compare the costeffectiven ess of la paroscopic-assisted vaginal hysterectomy to traditional total abdominal hystere ctomy and total vaginal hysterectomy with regard not only to direct hospital cos ts but also to indirect costs. Study design This was a combined retrospective co hort study (Canadian Task Force classification II-2) that was conducted in a su burban private practice. The cases of 268 patients who underwent hysterectomies over a 27-month period were analyzed to include clinical outcomes, direct hospi tal costs, and indirect costs (time to return to normal function, time to return to work, and time away from work required by other family members). Results For all patients, length of hospital stay and time of return to normal function wer e shorter for laparoscopic-assisted vaginal hysterectomy than for total abdomin al hysterectomy and total vaginal hysterectomy. For working patients, time to re turn to work and time off for working family members were all significantly shor ter after laparoscopic-assisted vaginal hysterectomy when compared with both to tal abdominal hysterectomy and total vaginal hysterectomy. Operating times were similar for total abdominal hysterectomy and laparoscopic-assisted vaginal hyst erectomy, and complications were greater for total abdominal hysterectomy. In a comparison of all procedures, direct hospital costs were greatest for laparoscop ic-assisted vaginal hysterectomy and least for total vaginal hysterectomy. Conc lusion For most patients, laparoscopic-assisted vaginal hysterectomy provides a minimally invasive way to accomplish a hysterectomy with a lower cost to employ ers (payers) on the basis of lost work hours. Objective The purpose of this study was to compare the costeffectiven ess of la paroscopic-assisted vaginal hysterectomy to traditional total abdominal hysterectomy and total vaginal hysterectomy with regard not only to direct hospital cos ts but also to indirect costs. Study design This was a combined The cases of 268 patients who underwent hysterectomy over a 27-month period were analyzed to include clinical outcomes, direct hospi tal costs, and indirect costs (time to return to normal function, time to return to work, and time away from work required by other family members). Results For all patients, length of hospital stay and time of return to normal function wer e shorter for laparoscopic- assisted vaginal hysterectomy than for total abdomin al hysterectomy and total vaginal hysterectomy. For working patients, time to re turn to work and time off for workin g family members were all significantly shor ter after laparoscopic-assisted vaginal hysterectomy when compared with both tal abdominal hysterectomy and total vaginal hysterectomy. Operating times were similar for total abdominal hysterectomy and laparoscopic-assisted vaginal hyst erectomy, and complications were greater for total abdominal hysterectomy. In a comparison of all procedures, direct hospital costs were greatest for laparoscop ic-assisted vaginal hysterectomy and least for total vaginal hysterectomy. Conc lusion For most patients, laparoscopic-assisted vaginal hysterectomy provides a minimally invasive way to accomplish a hysterectomy with a lower cost to employ ers (payers) on the basis of lost work hours.