Association of surgical approach on outcomes after benign hysterectomy: a comparative cohort study

Benign hysterectomy can be performed using multiple surgical approaches, each associated with distinct perioperative and postoperative outcomes. Comparative real-world data across commonly used techniques remain limited. To evaluate the association between surgical approach and perioperative outcomes after benign hysterectomy and to describe differences in safety profiles across five hysterectomy techniques.

This retrospective single-center cohort study included consecutive women undergoing hysterectomy for benign indications between January 2023 and December 2025. Outcomes of vaginal, laparoscopic, and abdominal surgical approaches were compared. RR with 95% CI was calculated for perioperative and postoperative outcomes, with vaginal hysterectomy as the reference group.

A total of 793 patients were included. Perioperative and postoperative outcomes differed significantly among hysterectomy approaches, including operative time, complication rates, rehospitalization, reoperation, conversion, and length of hospital stay. Vaginal hysterectomy was associated with the shortest operative time, shortest hospital stays, and lowest complication rates, whereas total laparoscopic and total abdominal hysterectomy were associated with the highest complication rates. RR analysis suggested an increased risk of perioperative and postoperative complications after total laparoscopic and total abdominal hysterectomy compared with vaginal hysterectomy.

Perioperative and postoperative outcomes after benign hysterectomy differ significantly according to surgical approach. These findings suggest that surgical approach may be associated with differences in perioperative outcomes and support individualized route selection.