Vaginal and laparoscopic hysterectomies have been clearly associated with decreased blood loss, shorter hospital stay, speedier return to normal activities, and fewer abdominal wall infections when compared with abdominal hysterectomies.
In light of these findings, a recent review concluded that vaginal hysterectomy is preferable to abdominal hysterectomy and that a laparoscopic hysterectomy should be attempted when vaginal hysterectomy is not possible. The vaginal approach is less expensive, but may be challenging in patients with a history of an adnexal mass, endometriosis, pelvic pain, and prior abdominal surgery, or in patients with a narrow pubic arch or poor vaginal descent.
The relatively slow adaptation of laparoscopic hysterectomy may in part be attributed to inadequate exposure and training during residency.