Reaffirming the role of vaginal hysterectomy in the era of minimally invasive surgery: a comparative study of three surgical techniques

Aims: Hysterectomy remains one of the most frequently performed gynecologic procedures. While minimally invasive techniques such as laparoscopy and robotic-assisted surgery have improved precision and visualization, the vaginal approach being the least invasive, most cost-effective, and physiologically natural route-continues to hold clinical importance. This study aimed to reassess the relevance of vaginal hysterectomy compared with laparoscopic and robotic techniques by evaluating surgical, economic, and recovery-related outcomes over a ten-year institutional period. Methods: This retrospective cohort study was conducted between January 2014 and May 2022 in a tertiary referral center. A total of 675 hysterectomy cases were reviewed, and after applying inclusion and exclusion criteria, 487 (72.2%) vaginal, 156 (23.1%) laparoscopic, and 32 (4.7%) robotic procedures were analyzed. Operative time, blood loss, postoperative complications, hospital stay, and healthcare cost were compared across groups using appropriate statistical tests, with significance set at p<0.05. Results: Postoperative complications occurred in 9.1% of patients, most commonly urinary tract infection (1.3%), surgical site infection (1.0%), and adhesions (0.9%). Hysterectomy type showed no significant association with healthcare cost, complication rate, or 30-day readmission. Significant differences were found for operative time, cost, blood loss, and hospital stay (p<0.05). Robotic hysterectomy yielded the lowest blood loss but longer duration and higher cost, whereas vaginal hysterectomy offered superior efficiency and cost-effectiveness without compromising safety. Conclusions: Vaginal hysterectomy remains a valuable, efficient, and safe surgical option in modern practice, supporting individualized surgical planning based on patient characteristics and institutional resources.