Vaginal Hysterectomy vs Laparoscopic Hysterectomy for Benign Indications

Complications and Length of Stay in a National Analysis of Contemporary Data

[Posted 3/Mar/2026]

AUDIENCE: Ob/Gyn, Oncology

KEY FINDINGS: Complication rates were low after vaginal hysterectomy and laparoscopic hysterectomy. The study results suggest that vaginal hysterectomy is not clearly a preferred route for hysterectomy over laparoscopic hysterectomy. The data support further investigation of the optimal surgical approach for hysterectomy with large, prospective clinical studies.

BACKGROUND: The current recommendation to select vaginal hysterectomy for benign indications whenever feasible is based on clinical trials with limited cohorts and older data. This study aimed to evaluate the association between the hysterectomy route (vaginal hysterectomy or laparoscopic/robotic hysterectomy) and short-term outcomes.

DETAILS: A cohort study was conducted using prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2022. Women who underwent vaginal hysterectomy or laparoscopic hysterectomy for benign indications were included. Abdominal hysterectomies, laparoscopic/robotic supracervical hysterectomies, laparoscopic-assisted vaginal hysterectomies, and emergent surgical procedures were excluded. Propensity score matching and multivariate regression analyses were performed to assess outcomes. The primary outcome was the occurrence of complications within 30 days, which was stratified using the Clavien-Dindo classification. The secondary outcomes included operative time, overnight admission, and hospital length of stay. After propensity score matching for patients’ demographics and surgical characteristics, including uterine weight (<250 g or >250 g) and concomitant procedures performed, 83,436 women were included in the analysis, with 41,718 patients each in the vaginal hysterectomy and laparoscopic hysterectomy groups in a 1:1 ratio. Postoperative complications were low in the vaginal hysterectomy and laparoscopic hysterectomy groups (8.2% vs 6.4%, respectively; P<.001; adjusted odds ratio, 1.23 [95% confidence interval, 1.15-1.31]). Major and minor complication risks were minimally increased in the vaginal hysterectomy group. Specifically, vaginal hysterectomy was associated with higher risks of blood transfusion, urinary tract infection, organ/space infection, and reoperation, and laparoscopic hysterectomy was associated with higher risks of wound dehiscence and pulmonary embolism. Operative time was shorter in the vaginal hysterectomy group than in the laparoscopic hysterectomy group (109.6 vs 137.0 minutes, respectively; P<.001). The proportions of overnight admission were 35.5% after vaginal hysterectomy and 27.2% after laparoscopic hysterectomy (adjusted odds ratio, 2.10 [95% confidence interval, 2.02-2.18]). Hospital lengths of stay for >=1 day were 77.9% in the vaginal hysterectomy group and 77.1% in the laparoscopic hysterectomy group (adjusted odds ratio, 1.90 [95% confidence interval, 1.82-1.99]). In addition, hospital lengths of stay for >=2 days were 13.2% in the vaginal hysterectomy group and 10.1% in the laparoscopic hysterectomy group (adjusted odds ratio, 1.55 [95% confidence interval, 1.47-1.63]).

Copyright © 2025 Elsevier Inc. All rights are reserved.

Source: Meyer, R., Hamilton, K. M., Ezike, O., et al. Vaginal Hysterectomy vs Laparoscopic Hysterectomy for Benign Indications: Complications and Length of Stay in a National Analysis of Contemporary Data. American Journal of Obstetrics & Gynecology. 2026; 234(3): 620-631. Published: March, 2026. DOI: 10.1016/j.ajog.2025.10.027.