Hysterectomy is performed for benign (e.g., symptomatic leiomyomas, pelvic organ prolapse, AUB, endometriosis, chronic pain, premalignant neoplasia) and malignant conditions (Hoffman et al., 2012f). The approach may be abdominal, vaginal, or laparoscopic, determined by physical properties of uterus and pelvis, diagnosis, surgical indications, presence or absence of adnexal pathology, surgical risks, costs, recovery, and quality of life issues. Abdominal hysterectomy may be preferred for large pelvic organs, extensive adhesions, if oophorectomy is needed, or if additional urogynecologic procedures are planned. While the abdominal approach usually requires less operating time and specialized instrumentation and expertise than laparoscopic approaches, the recovery time is longer, pain is increased, and there is a greater risk of infection and fever. Postoperative bleeding and bladder injury are lower with abdominal incisions compared with the vaginal approach, but transfusion and ureteral injury may be greater. Smaller pelvic organs, minimal adhesions, no significant adnexal pathology, and minimal pelvic organ prolapse support the vaginal approach to hysterectomy. Recovery is faster, there is lower cost, and pain is less than with abdominal incisions. Laparoscopic approaches require longer operating times, more expensive equipment, and extensive surgical skill. The indications are similar to vaginal hysterectomy as are the postoperative outcomes; however, the laparoscopic approach offers greater visualization and access to the abdomen and pelvis. Risk of ureteral injury is higher than either the abdominal or vaginal approach. Postoperative care for abdominal hysterectomy is similar to that of any major abdominal procedure. Length of stay may be up to 4 days. Complications include fever, which may be due to pelvic, abdominal wall, or urinary tract infection; abscess; hematoma; or pneumonia. Patients who have vaginal hysterectomies recover normal bowel function, ambulate easier, and have less pain than patients who have abdominal hysterectomies.