**5. Techniques**

Regarding hysterectomy techniques, the procedure can be performed through the vagina, the abdomen or by laparoscopy. The decision will depend on the indication for the operation, past abdominal surgery, current medical conditions, weight, available equipment and surgeon's expertise.

Abdominal hysterectomy, also known as traditional open surgery, is performed through an abdominal incision, mostly by Pfannenstiel incision, and less frequently through an up and down incision. It is more recommended in cases of very large uterus, in cases of malignancies, and associations with other organ pathologies. This traditional approach is associated with relatively more post-operative pain and slightly longer hospital stay.

At vaginal hysterectomy the uterus is excised through an incision at the vaginal vault, thus avoiding an abdominal incision. This procedure is preferred in cases of uterine prolapse, vaginal walls laxity, stress incontinence and deficient perineum. To be eligible for a vaginal hysterectomy, the uterus must be of a certain size as it is not very suitable in cases of large pelvic masses and suspected malignancies.

Laparoscopic hysterectomy is a minimally invasive procedure using laparoscopic surgery where the uterus is removed through the vagina. The procedure seems to combine "the best of both worlds". It is associated with fewer complications in the suitably selected cases and the availability of adequate instruments, surgical expertise and assistance.

Robotic hysterectomy is laparoscopic surgery that is aided by a robot that allows the performance of more complex procedures with better precision. The technology includes specialized arms for instrument holding, a camera, and a magnified screen and a console. This allows a greater range of motion and dexterity for better access to the area of interest. Recovery is similar to traditional laparoscopic surgery.
