Dr Dietl et al note that the recent Food and Drug Administration (FDA) safety communications on power morcellation provide an opportunity to improve vaginal hysterectomy rates and proficiency. Our study did find an increase in vaginal hysterectomy rates in Michigan after the FDA warning regarding power morcellation. Nationally, vaginal hysterectomy rates have been in the decline over the last decade, despite a Committee Opinion from the American College of Obstetricians and Gynecologists that recommended vaginal hysterectomy as the preferred route of hysterectomy for benign disease.

The Society of Gynecologic Surgeons’ Education Committee has identified 3 factors that are associated with this trend: (1) inadequate residency training because of diminished available cases, (2) difficulty preserving surgical skills because of low surgical volumes after residency, and (3) increased commercial marketing of laparoscopic and robotic-assisted hysterectomy techniques. The FDA warning indirectly may increase the vaginal hysterectomy use through counteracting all 3 of these factors that were identified by the Society of Gynecologic Surgeons. If the use of morcellation continues to decrease and abdominal approaches to hysterectomy do not increase greatly, the FDA policy may actually be an opportunity to improve surgical options for women by increasing the incidence of vaginal hysterectomy.

To capitalize on this early change in practice, it will be important to continue to develop effective training for residents and coaching for young practicing gynecologists to increase the use of the safe and effective vaginal hysterectomy approach successfully.