ObjectivesTo determine the effectiveness and safety of vaginal hysterectomy compared with abdominal and laparoscopic vaginal hysterectomy.MethodsA total of 615 women underwent abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy. Operating time, route of hysterectomy, need of blood transfusion, operative and postoperative complications, route conversion to laparotomy, and length of hospital stay were recorded for each case.ResultsVaginal hysterectomy was successfully performed in 413 women (67%), abdominal hysterectomy in 182 (30%), and laparoscopically assisted vaginal hysterectomy in 20 (3%). In 8 cases (2%), vaginal hysterectomy failed and was converted to abdominal hysterectomy. Vaginal hysterectomy was associated with shorter operating time and hospital stay than abdominal hysterectomy. The vaginal approach was used in 292 women with nonprolapsed uterus, a number of whom had uterine fragmentation (74 cases). The average operating time was 92 minutes (range, 30–290 minutes), the average postoperative hospitalization was 96 hours, and the average uterine weight was 199 g (range, 20–2020 g), considering all types of hysterectomy.ConclusionsVaginal hysterectomy is an effective and safe procedure, even for nonprolapsed uterus. This route of hysterectomy is associated with fewer complications and a shorter length of hospital stay when compared with abdominal hysterectomy, with subjacent health and economic benefits. The lack of training in vaginal surgery is one of the principal reasons that vaginal hysterectomy is not the predominant procedure. Teaching skills in vaginal surgery will increase the number performed by this route compared with the abdominal approach.