Comment on “Vaginal Hysterectomy vs Laparoscopic Hysterectomy for Benign Indications: Complications and Length of Stay in a National Analysis of Contemporary Data”

The most common gynecologic surgery in the United States is hysterectomy, which can be performed via an open laparotomy, vaginal, or laparoscopic route. Currently, the most common approaches for benign indications are minimally invasive abdominal surgery via laparoscopic or robotic-assisted techniques. Vaginal hysterectomy, however, is still recommended over laparoscopic by the American College of Obstetricians and Gynecologists due to existing evidence supporting shorter operative time, lower cost, and fewer complications. Recent advances in the efficiency of the laparoscopic approach necessitate a reassessment of these previous conclusions. This study was designed to explore the association between minimally invasive vaginal or laparoscopic (VH or LH) procedures for benign indications and short-term outcomes and complications. This was a retrospective cohort study using data from the NSQIP database. Propensity score matching was used to select patients. Inclusion criteria were undergoing VH or LH for benign indications between 2012 and 2022. Exclusion criteria were laparoscopic supracervical hysterectomy, laparoscopic-assisted vaginal hysterectomy, malignancy, concomitant lymphadenectomy, nonelective procedures, patients who were on a ventilator, and preoperative sepsis. The primary outcome was postoperative complications within 30 days, and secondary outcomes included operative time, overnight admission, and hospital length of stay. The final analysis included 83,436 patients, with 41,718 in each of the VH and LH groups. VH showed significantly shorter operative time but a higher proportion of overnight admissions ( P <0.001 for both). There were no significant differences in length of stay (LOS) between the 2 groups when the LOS was analyzed as continuous data. However, when stratifying the cohort into patients who stayed at least 1 full day, the LOS was longer in the VH group compared to the LH group ( P =0.007). The VH group also exhibited a higher proportion of any complication within 30 days ( P <0.001), which held true for both major and minor complications separately ( P <0.001 for both). VH was associated with a greater likelihood of blood transfusion, urinary tract infection, organ space surgical site infection, sepsis, and reoperation ( P <0.001 for all). Wound dehiscence and pulmonary embolism, however, were more likely in the LH group ( P <0.001 and P =0.008, respectively). These results indicate that though both VH and LH were associated with a low risk of complications, there was an overall minimally increased risk of complications in VH compared to LH. This is consistent with previous literature in large cohorts, and this study contributes to this evidence over a larger sample and longer time period. Recent evidence, such as this, may be more beneficial when forming clinical guidelines than the previous research that was used when issuing the guideline for VH as the preferred method. Future research should focus on evaluating whether these results are robust to hospital settings, clinician factors, and diverse patient populations. In addition, future studies should assess whether current guidelines should be updated based on emerging evidence. (Summarized from Meyer R, Hamilton KM, Ezike O, et al. Vaginal hysterectomy vs laparoscopic hysterectomy for benign indications: complications and length of stay in a national analysis of contemporary data. Am J Obstet Gynecol . 2026;234(3):620-631. doi: 10.1016/j.ajog.2025.10.027).