358 24 Michael Stark Sandro Gerli Gian Carlo Di Renzo The Ten-Step Vaginal Hysterectomy Vaginal hysterectomies were already being performed in the 19th century, the first by Langenbeck in 1813. 1,2 Since then, many modifications and variations have been reported. Most methods in use today, like the Porges, 3 Falk, 4 von Theobald, 5 Heaney, 6 Joel-Cohen 7 and the Chicago 8 methods, are carried out with defined sequences. These sequences result from personal interpretations of the pelvic anatomy and the individual experience of the authors. Innovative procedures such as focused ultrasound 9 and cryomyolysis to reduce the size of fibroids 35 or endometrial resection and microwave treatment for endometrial ablation in uncontrolled vaginal bleedings 10 have reduced the number of all kinds of hysterectomies. These days, hysterectomies are often performed as laparoscopically assisted vaginal hysterectomies (LAVH), even for big uteri. 11 In a prospective, randomised study, no difference between vaginal hysterectomy and LAVH was found with respect to estimated blood loss, complications, hospital stay and period of convalescence. The costs of LAVH were, however, considerably higher. 12 Even today, with hundreds of publications about laparoscopically assisted vaginal hysterectomy available, the vaginal route should always be considered when hysterectomy is indicated, because of the quick recovery, the lack of abdominal scar and the short hospital stay. 6,13 It seems that laparoscopically Michael Stark MD (for correspondence) President, The New European Surgical Academy (NESA) and Chairman of the Gynaecological Departments, HELIOS Hospitals Group, Karower Str 11, Haus 214, 13125 Berlin, Germany E-mail: mstark@nesacademy.org Sandro Gerli MD Senior Gynaecologist, Department of Obstetrics and Gynaecology, Monteluce Hospital, University of Perugia, Italy Gian Carlo Di Renzo MD PhD Head, Department of Obstetrics and Gynaecology, Monteluce Hospital, University of Perugia, Italy/Italian Representative of the New European Surgical Academy (NESA)