Exclusion Criteria
| Adnexal disease as primary indication for surgery | Minimally invasive hysterectomy converted intraoperatively |
| Adnexal torsion | Müllerian or uterine anomalies |
| Age <18 years | Ovarian, fallopian tube, or primary peritoneal cancer |
| Cervical cancer more advanced than stage 1A1 | Pelvic kidney |
| Cesarean hysterectomy | Planned appendectomy, cholecystectomy, or bowel surgery |
| Concomitant anti-incontinence procedures | Planned umbilical hernia repair affecting route choice |
| Concomitant pelvic organ prolapse operation other than pure uterine | Radical hysterectomy |
| Emergent hysterectomy | Risk-reducing surgery (ie, BRCA positive) |
| Endometrial hyperplasia of increased complexity | Supracervical hysterectomy |
| History of multiple cone excisions with no available cervical tissue | Tubo-ovarian abscess |
| Laparoscopic hysterectomy or laparoscopy-assisted vaginal hysterectomy | Uterine cancer or suspicion for sarcoma |
| Mesh-related surgery or excision |