Determining the Route/Technique of Hysterectomy

ACOG: Although minimally invasive approaches to hysterectomy are the preferred route, laparotomic ("open" abdominal) hysterectomy remains an important surgical option for some patients. Laparotomy may be necessary when the vaginal or laparoscopic approach is not appropriate to manage the patient’s clinical situation, when facilities cannot support less invasive surgical approaches, or when an attempt at a minimally invasive route to hysterectomy fails intraoperatively.

https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/06/choosing-the-route-of-hysterectomy-for-benign-disease