{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:49:44Z","timestamp":1791308984144,"version":"4.3.1"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The rate of vaginal hysterectomies is declining globally. We investigated surgical techniques, outcomes, and costs in a large national cohort of benign hysterectomies with prerequisites for vaginal surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>A retrospective register\u2010based cohort study with benign hysterectomies in the Swedish GynOp registry 2014\u20132023 (<jats:italic>n<\/jats:italic>\u2009=\u200917\u2009804). Inclusion criteria were non\u2010prolapse, non\u2010endometriosis with uterus weight &lt;300\u2009g. The cohort was divided into a low\u2010risk and a standard group, with the low\u2010risk group having optimal conditions for vaginal hysterectomy: no previous caesarian section (CS), no previous abdominal surgery, Body Mass Index (BMI) &lt;30, and no nulliparous patients. Surgical outcomes were quantified using crude and adjusted risk ratios (RR, ARR). Costs were calculated and compared between abdominal (AH), laparoscopic (LH), robot\u2010assisted (RH), and vaginal hysterectomies (VH).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The rate of AH and VH decreased during the period studied. RH increased and was the most common surgical technique 2021\u20132023 (33.2%). VH had the shortest surgical time and was the cheapest method. In the low\u2010risk group, 25.2% of the patients were operated on vaginally. AH had more postoperative complications and longer hospitalization compared to VH in the low\u2010risk group. LH had less severe intraoperative complications, ARR\u2009=\u20090.38 (95% CI 0.17\u20130.86) but more mild postoperative complications, ARR\u2009=\u20091.24 (95% CI 1.05\u20131.46) compared to VH in the low\u2010risk group. LH had more conversions, ARR\u2009=\u20091.46 (95% CI 1.00\u20132.12), longer surgical time, ARR\u2009=\u20092.73 (95% CI 2.46\u20133.00) and longer hospital stay, ARR\u2009=\u20091.26 (95% CI 1.12\u20131.43) compared to VH. Mild (ARR\u2009=\u20090.33, 95% CI 0.16\u20130.66) and severe (ARR\u2009=\u20090.17, 95% CI 0.05\u20130.58) intraoperative complications and bleeding &gt;500\u2009mL (ARR\u2009=\u20090.12, 95% CI 0.04\u20130.34) were less common in RH versus VH in the low\u2010risk group. There were no differences between RH and VH regarding postoperative complications and reoperations. Surgical time &lt;45\u2009min was less common in RH versus VH (ARR\u2009=\u20090.47, 95% CI 0.42\u20130.54) and RH had a significantly longer postoperative hospital stay (ARR\u2009=\u20091.16, 95% CI 1.02\u20131.33).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A decline of vaginal hysterectomies in Sweden 2014\u20132023 among patients with prerequisites for vaginal surgery was shown. VH was the cheapest method with few postoperative complications and short hospitalization. Our results support the vaginal route in low\u2010risk hysterectomies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.15099","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T06:44:52Z","timestamp":1742366692000},"page":"958-967","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Why not vaginal?\u2014Nationwide trends and surgical outcomes in low\u2010risk hysterectomies: A retrospective cohort study"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6817-9161","authenticated-orcid":false,"given":"Johanna","family":"Wagenius","sequence":"first","affiliation":[{"name":"Institute of Clinical Sciences, Department of Obstetrics and Gynecology Lund University  Lund Sweden"},{"name":"Department of Obstetrics and Gynecology Helsingborg Hospital  Helsingborg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Ehrstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Division of Obstetrics and Gynecology Danderyd Hospital  Danderyd Sweden"},{"name":"Considra Gyn Nacka Hospital  Nacka Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5765-2630","authenticated-orcid":false,"given":"Karin","family":"K\u00e4ll\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Center of Reproduction, Epidemiology, Tornblad Institute Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Baekelandt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Imelda Hospital  Bonheiden Belgium"},{"name":"Department of Obstetrics and Gynecology, Development and Regeneration University of Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Stuart","sequence":"additional","affiliation":[{"name":"Institute of Clinical Sciences, Department of Obstetrics and Gynecology Lund University  Lund Sweden"},{"name":"Department of Obstetrics and Gynecology Helsingborg Hospital  Helsingborg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"Ehrstr\u00f6mS.Hysterektomi p\u00e5 benign indikation. \u00c5rsrapport fr\u00e5n GynOp\u2010registret avseende operationer utf\u00f6rda \u00e5r 2023. [Hysterectomy for benign indication. Annual report from the GynOp registry regarding operations performed in 2023.] In Swedish. GynOp \u00c5rsrapport 2023. p. 56. 240620 ed.2024https:\/\/www.gynop.se\/wp\u2010content\/uploads\/2024\/06\/Arsrapport\u2010hysterektomi\u2010op\u2010utford\u20102023.pdf"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318299a6cf"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004679"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.186"},{"key":"e_1_2_13_6_1","article-title":"Surgical approach to hysterectomy for benign gynaecological disease","volume":"8","author":"Pickett CM","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0000000000000489"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005643"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2020.101936"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0007340"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11701-019-00982-7"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2023.11.009"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.4293\/108680812X13462882736736"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2010.06.009"},{"key":"e_1_2_13_15_1","first-page":"197","article-title":"Clinical and cost comparisons for hysterectomy via abdominal, standard laparoscopic, vaginal and robot\u2010assisted approaches","volume":"64","author":"Landeen LB","year":"2011","journal-title":"SD Med"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2018.01.019"},{"key":"e_1_2_13_17_1","unstructured":"ACOG.Choosing the route of hyterectomy for benign disease. 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