ObjectiveTo investigate the cost advantages and complication rates associated with surgical routes of uncomplicated hysterectomies in which uteri weigh less than 280 g and benign diseases are confined to the uterus.MethodsData were collected prospectively from 1988 to 1993 from 4609 consecutive women who had hysterectomies at a single institution. Women who had abdominal hysterectomies, laparoscopically assisted vaginal hysterectomies, or vaginal hysterectomies were selected if they had benign diseases confined to the uterus (adenomyosis, leiomyomas, abnormal uterine bleeding, cervical carcinoma in situ, and prolapse) and uterine weights less than 280 g. We compared length of stay, hospital charges, and associated complications between groups.ResultsA total of 1427 women met the study criteria. Length of stay was longer after abdominal hysterectomies than laparoscopically assisted vaginal hysterectomies or vaginal hysterectomies (3.99 ± 1.16 days, 2.45 ± 1.58 days, and 2.76 ± 0.94 days, respectively;P< .001). Hospital charges for vaginal hysterectomies were significantly lower than for either abdominal or laparoscopically assisted vaginal hysterectomies (P< .001). The median charge for vaginal hysterectomies was $4166; the median charges for laparoscopically assisted vaginal hysterectomies and abdominal hysterectomies were 71% and 35% higher than this, respectively. There was a higher risk of one or more complications after abdominal hysterectomies (9.3%) than after laparoscopically assisted vaginal hysterectomies (3.6%;P< .001) or vaginal hysterectomies (5.3%;P< .001). The incidence of postoperative infection or fever was higher after abdominal than after vaginal hysterectomies (4.0% versus 0.8%;P= .029).ConclusionThis study supports the vaginal route of hysterectomy when disease is confined to the uterus and uterine weight is less than 280 g.