Minimally invasive gynecologic surgery is currently a standard approach for the treatment of most gynecologic conditions. This presentation provides a summary of the factors that should guide the patient selection for minimally invasive hysterectomy. Briefly, to decide the route of hysterectomy, the clinicians should assess cases by a focused history, physical examination and pelvic ultrasound, take into account: (1) indication for hysterectomy, (2) relative risks and benefits of each hysterectomy route, (3) uterine size, shape, accessibility & mobility, (4) patient´s characteristics and concomitant pathology, (5) surgeon’s competence and preference, (6) patient’s preference, and (7) available support facilities. The vaginal hysterectomy should be considered as the 1st choice for benign indications, being best performed if the uterus is less than 12 weeks of gestation or ≤ 280 g (clinical/ultrasound estimation), if accessible vaginally and if the pathology is confined to the uterus.