Vaginal hysterectomy has been established as a preferred route of hysterectomy because of the best clinical outcomes and lowest costs [1–3]. In addition, it can be performed under neuraxial anesthesia [4, 5]. A 2015 Cochrane review demonstrated that patients undergoing vaginal hysterectomy, as compared to other routes, had shorter operative times and hospital stay, greater patient satisfaction, and quicker return to activity compared to laparoscopic and abdominal hysterectomy [2]. This review also examined the evidence behind vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy and concluded that more studies are needed before broader conclusions can be drawn. Unfortunately, many barriers resulted in the continued and consistent decline in the rate vaginal hysterectomies over the past decade in the United States [6–13].