Harris et al describe a significantly reduced number of laparoscopic supracervical hysterectomy after the Food and Drug Administration had issued a safety communication that the laparoscopic surgical approach is associated with more major postoperative complications (excluding blood transfusions). In response, the number of vaginal hysterectomies (VH) has increased.

Laparoscopic morcellator-related complications like the spread of undetected malignancies are unknown after VH. Surgical site infections are extremely rare after VH. VH is the most cost-efficient of all minimally invasive methods and has the shortest operating time of all hysterectomy procedures. Per 10 minutes of operating time, the risk of venous thromboembolism is increased by 4%. According to the American College of Obstetricians and Gynecologists’ committee, the following hysterectomy procedures are recommended: VH should be first choice followed by laparoscopic hysterectomy and abdominal hysterectomy. Daily clinical practice suggests that VH that is performed by an experienced surgeon is the method with the highest patient satisfaction. With appropriate professional supervision, as in the FINHYST study, the proportion of VH can be more than doubled within a given period, which significantly reduces the complication rate.

Because of the rise of new technologic developments in the field of minimally invasive surgery, there is a serious risk that VH will become a forgotten historic operation. This would be to the disadvantage of women who need to have their uterus removed because of benign diseases. VH leaves no scarring because it can be performed through a natural orifice and removes the whole cervix, which might otherwise experience abnormalities that will require further surgery.

Having multiple options for different clinical scenarios is a sign for medical progress and is most welcome. Still, the industrially funded development should not guide clinical decision-making, and the surgical skills to perform VH should be preserved. As gynecologic surgeons, we must aim to provide the safest care for our patients. This includes VH in well-trained hands that should be used whenever possible, even more so after the Food and Drug Administration warning.