OBJECTIVES: This study aims to identify the range of direct hospital costs associated with a minimally invasive or open hysterectomy procedure across different countries. METHODS: A PubMed search was performed using the keywords: hysterectomy [MeSH] and cost/economic/comparison with results limited to publications of human subject studies in English from 2006 to November 2015. Studies comparing minimally invasive surgical techniques (laparoscopic or laparoscopic-assisted) to open surgical techniques were selected and studies of comparisons other than minimally invasive versus open procedures (e.g. robotic or vaginal) were excluded. All abstracts were filtered, including meta-analysis, RCTs and observational studies excluding case studies. RESULTS: Thirty-one of 89 articles were included in the analysis. Fourteen (45%) studies were conducted in North America with the remaining based in European and Asian-Pacific countries. Direct hospital costs varied dramatically across countries. In North America, the cost of operating rooms (minute) ranged from $8-$10 for open procedures and $7-$9 for laparoscopies. The anesthesia cost (minute) ranged from $7-$11 and the cost for hospital stay (day) ranged from $215-$777 regardless of procedure type. In European countries, the cost of operating rooms (minute) ranged from $8-$26 for open procedures and around $12 for laparoscopy. The cost for hospital stay (day) ranged from $407-$1036. In Asia, the cost of operating rooms (minute) ranged from $5-$7 for open procedures and $8-$9 for laparoscopies. CONCLUSIONS: European countries have reported higher direct hospital costs. The evidence in addition to perioperative outcomes regarding direct hospital costs in Asian-Pacific countries is relatively limited. Comparison of direct hospital costs is challenging due to different costing structures and variations in reimbursement and clinical practices across countries. A standardized costing methodology guideline is warranted and may shed light on the future considerations of reimbursement strategy.