Vaginal hysterectomy, when feasible, is the safest and most cost-effective route for hysterectomy, however, when this is not possible, minimally invasive hysterectomy is often the next best option. Laparoscopic hysterectomy has advanced significantly since 1988, when it was first introduced. Continued improvements in instrumentation, energy sources, hemostatic agents, and vaginal cuff closure techniques have expanded the use of minimally invasive hysterectomy. Variations of laparoscopy, specifically laparoendoscopic single-site surgery hysterectomy and robotic-assisted laparoscopic hysterectomy, have further expanded the role of minimally invasive hysterectomy with the goal of decreasing morbidity. As with any evolving technology, well-designed studies are needed to demonstrate safety, efficacy, and cost-effectiveness before wide-spread adoption.