Since the total hysterectomy (TH) was introduced in 1929 by the American surgeon EH Richardson it has become the standard way of removing the uterus. Nonetheless, with a decline in the incidence of cervical cancer after the introduction of mass screening programmes in the 1970s, the enduring debate was revived as whether subtotal hysterectomy (SH) confers advantages over TH as regards perioperative morbidity, and urinary, bowel, and sexual function, because it entails less neuroanatomical disruption. A recent Cochrane Review of nine randomised controlled trials (RCTs) including 1553 participants found no difference between TH and SH up to 9 years after surgery regarding quality of life measures, and in the rates of outcomes that assessed urinary, bowel, or sexual function. There was also no difference in the rates of complications, recovery, readmission, or alleviation of pre-surgery symptoms between TH and SH performed through the abdominal or laparoscopic route, although trials comparing the laparoscopic route were underpowered to detect some differences. Nevertheless, persistent cyclical vaginal bleeding was reported by 13% of women after SH. The only three findings in favour of SH are unlikely to constitute significant clinical benefits: shorter operation time (by 11 minutes), less intraoperative blood loss (57 ml), and less likely postoperative pyrexia (8 versus 14%, OR 0.48, 95% CI 0.3–0.8) and urinary retention (OR 0.23, 95% CI 0.1–0.8) (Lethaby et al. Cochrane Database of Systematic Reviews 2012;4:CD004993). Another meta-analysis, including eight RCTs and 15 observational studies, and using the end points of self-reported symptoms, showed similar results to the Cochrane review. In addition, some women with previous normal smear history had abnormal cytology during the follow-up after SH (Gimbel Acta Obstet Gynecol 2007;86:133–44). The reduced likelihood of postoperative pyrexia with SH was also reported in a Swedish register-based study (Löfgren et al. Acta Obstet Gynecol 2004;83:1202–7). Although this could be explained by the contamination of the abdominal cavity from the vaginal flora during TH, the fact that studies reported pyrexia differently and that prophylactic antibiotic regimens were different, or not applied rigorously, cannot be ignored. This should not be clinically significant when strict antibiotic prophylaxis policies are implemented. Women undergoing SH incur the risk of undergoing subsequent trachelectomy for stump-related symptoms, particularly persistent bleeding (Ewies and Olah BJOG 2000;107:1376–9). The trachelectomy rate was 23% in a retrospective observational study assessing the long-term outcome of 70 laparoscopic SHs, despite routinely performing reverse conisation with SH (Okara et al. BJOG 2001;107:1376–9). Moreover, the remaining endometrial tissues would necessitate prescribing a progestogen component, with its known adverse effects, for women requiring estrogen replacement therapy. In summary, the perception that SH offers better clinical outcomes than TH is not confirmed by RCTs. In contrast, the stump-related problems are substantial. The American Congress of Obstetricians and Gynecologists (ACOG) stated that SH should not be recommended by the gynaecologists as superior to TH for benign gynaecological conditions (Committee Opinion 388, Obstet Gynecol 2007;110:1215–7; reaffirmed 2010). Certainly, SH is a backwards step and not a surgical advance in gynaecological practice, and may reflect the increasing erosion of gynaecological surgical skills. None to declare.