This review evaluates the effectiveness and safety of different surgical approaches to hysterectomy for benign gynecological conditions. The four main approaches are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), and robotic-assisted hysterectomy (RH). The review includes 47 studies with 5102 women, primarily comparing VH, AH, LH, and RH. Key findings include: 1. **VH vs. AH**: VH results in a shorter return to normal activities (mean difference -9.5 days, 95% CI -12.6 to -6.4) compared to AH, with no significant differences in other outcomes. 2. **LH vs. AH**: There is no significant difference in return to normal activities between LH and AH, but LH has a higher risk of bladder or ureter injury. 3. **LH vs. VH**: No significant differences in any primary outcomes were found between LH and VH. 4. **RH vs. LH**: No significant differences in any primary outcomes were found between RH and LH. The authors conclude that VH is superior to AH and LH due to faster recovery and fewer postoperative complications. When VH is not feasible, LH is a viable alternative, but it has a longer operation time and a higher risk of urinary tract injuries. Robotic-assisted hysterectomy (RH) showed no benefits over other methods. The evidence is of moderate to low quality due to poor reporting and imprecision. The choice of surgical approach should be discussed with the patient, considering their specific circumstances and preferences.This review evaluates the effectiveness and safety of different surgical approaches to hysterectomy for benign gynecological conditions. The four main approaches are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), and robotic-assisted hysterectomy (RH). The review includes 47 studies with 5102 women, primarily comparing VH, AH, LH, and RH. Key findings include: 1. **VH vs. AH**: VH results in a shorter return to normal activities (mean difference -9.5 days, 95% CI -12.6 to -6.4) compared to AH, with no significant differences in other outcomes. 2. **LH vs. AH**: There is no significant difference in return to normal activities between LH and AH, but LH has a higher risk of bladder or ureter injury. 3. **LH vs. VH**: No significant differences in any primary outcomes were found between LH and VH. 4. **RH vs. LH**: No significant differences in any primary outcomes were found between RH and LH. The authors conclude that VH is superior to AH and LH due to faster recovery and fewer postoperative complications. When VH is not feasible, LH is a viable alternative, but it has a longer operation time and a higher risk of urinary tract injuries. Robotic-assisted hysterectomy (RH) showed no benefits over other methods. The evidence is of moderate to low quality due to poor reporting and imprecision. The choice of surgical approach should be discussed with the patient, considering their specific circumstances and preferences.