The gold standard treatment for endometrial cancer is surgery. Less invasive surgical procedures (e.g. vaginal surgery), provide equivalent cure rates and are preferred interventions for elderly women or women with significant co-morbidities with endometrial cancer stage I. A commonly referred limitation of vaginal surgery in endometrial carcinoma is the difficulty of carrying out lymphadenectomy when necessary. However, women elected for vaginal procedures are those who should not need lymphadenectomy because they are at low risk for lymph-node metastasis, and can therefore be treated by less invasive surgery with similar oncology outcomes to those women treated with abdominal surgery. Vaginal hysterectomy, therefore, has a definite place in the therapeutic armamentarium of the gynaecological oncologist. Although it is not recommend routinely or indiscriminately, its use adds flexibility to the management of selected women with stage I endometrial carcinoma, without affecting their oncologic outcomes.