In 1843, Charles Clay described the first abdominal subtotal hysterectomy, and in 1991 Semm reported the first laparoscopic subtotal hysterectomy (LSH). To date, however, the question of whether to preserve or remove the hysterectomy remains controversial. Surgeons use sexual satisfaction or prevention of pelvic floor organ prolapse as indications for preserving the cervix. Because the absolute indication for hysterectomy is malignancy or precancerous lesions, the best surgical option for hysterectomy corresponding to other indications is still under discussion. Intraoperative considerations 1. Cervical dissection Hysterectomy remains the most common gynecologic procedure and is closely associated with patient satisfaction. When a patient decides to undergo laparoscopic hysterectomy, consideration needs to be given to whether to preserve or remove the cervix. lSH can be performed laparoscopically through multiple holes, a single hole, or with robotic assistance. Considerations for the procedure include the level of cervical dissection and the way the uterine body is removed. Both LSH and laparoscopic total hysterectomy (TLH) procedures are identical prior to uterine vascular ligation. After uterine vascular ligation, LSH cuts across the cervix at the level of the internal os (i.e. between the endometrium and the cervical columnar epithelium). If a hysterectomy device is used, it is usually performed here. The hysterectomy can be performed with “cold knife”, “ultrasonic knife” or “electronic surgical instruments”. 2. Endocervical excision or electrocoagulation Methods to reduce postoperative cyclic bleeding include excision of the remaining endocervical lining and electrocoagulation. In one study, there was no significant difference in the interval of postoperative vaginal bleeding between women who underwent both LSH and laparoscopic cervical conization (conization group) and those who underwent only LSH (no conization group). Vaginal bleeding was observed in 33% of women in the non-conization group and in 37% of women in the conization group. In the study of 400 patients who underwent cervical tube electrocoagulation, only 2% had intermittent postoperative vaginal bleeding. In contrast, all women who underwent additional procedures on residual endocervical tissue had intermittent vaginal bleeding. The removal of the uterine body is a central component of the LSH procedure. In the past, this operation could be performed through an enlarged abdominal incision or by incision of the posterior vaginal fornix using a simple mechanical crusher. Subsequently, new techniques have been introduced, including modified manual comminution techniques and electromechanical surgical comminutors, where the comminuted tissue fragments can be removed through the comminutor, a single hole, or the posterior vaginal fornix. Also, separation and extraction of the uterus by hysteroscopy has been reported in the literature. Since these methods have not been compared, it is not possible to determine the superiority of one technique over another. Therefore, the choice of extraction method will depend more on obstetrician-gynecologist preference and available equipment.