Robot-assisted hysterectomy (RH) is undisputedly the most expensive surgical procedure to remove the uterus whereas vaginal hysterectomy (VH) is the most cost-efficient of all minimally invasive methods. Nevertheless, laparoscopic hysterectomy (LH) and RH are exclusively promoted as minimally invasive procedures and thus becoming even more popular. VH, in contrast, is gradually being displaced. Accordingly, resident physicians may no longer receive sufficient training to become proficient in this classic gynecologic surgery. From a patient perspective, however, VH should not fall into oblivion since it represents the least invasive surgical option with the lowest perioperative complexity. In fact, laparoscopic approaches to hysterectomy offer no medical advantages over VH. Instead, VH performed by an experienced surgeon is still the method requiring the shortest operation time and consuming the least resources. Moreover, laparoscopy-related postoperative pain is avoided. Clinical routine further teaches us that VH is preferable for older and less mobile patients. Accordingly, the exorbitant increase in RH and LH can best be explained by a marketing effect (“new operation–new patients”) combined with a less restrictive clinical indication.

Marketing by industry and hospital World Wide Web sites describing only the benefits of the laparoscopic methods do, however, represent powerful allies for RH and LH. As a result, patients will undoubtedly be influenced in their decision. VH, in contrast, does not require sophisticated instruments or novel techniques and hence offers few “market opportunities.” Nevertheless, the trend toward LH and RH appears highly detrimental to women who need to have their uterus removed due to benign diseases–and to young gynecologists during their residency training. It thus needs to be emphasized that VH, which leaves no scars and contributes to the utmost satisfaction of patients, is the really minimally invasive hysterectomy. Accordingly, whenever there is the clinical need for hysterectomy, VH is in the best interest of the patient and should therefore be the method of choice. Other techniques should rather be reserved for those cases where VH is technically not feasible.