Objective To compare the advantages and outcomes of modified total laparoscopic hysterectomy (TLH) with total transvaginal hysterectomy (TVH) in obese patients with large uterus (uterine size≥12 weeks). Methods 103 obese patients underwent total hysterectomy due to hysteromyoma, including 54 cases with modified total laparoscopic hysterectomy (TLH group) and 49 cases with total vaginal hysterectomy (TVH group). Operative duration, intraoperative blood loss, uterine weight, postoperative anal exhaust time, cost and incidence of perioperative complications were compared between two groups. Results In the TLH group, modified TLH was completed uneventfully in 51 cases, and conversion to TVH was performed in 2 cases, conversion to open operation in one case. In the TVH group, TVH was completed in 48 cases and conversion to open operation was conducted in one case. The operation duration in the TLH group was shorter than the TVH group ［(113.0±33.8) min vs (146.8±43.4) min, P＜0.05］. And the mean intraoperative blood loss was less in the TLH group compared with the TVH group ［(94.2±50.1) mL vs (138.0±48.0) mL, P＜0.05］.The mean cost of the TVH group was lower and that of the TLH group［(5 543±1 054) yuan vs.(7 749±1 110) yuan, P＜0.05)］. There was no significant difference in the postoperative anal exhaust time, uterine weight and incidence of perioperative complications between two groups (P=0.594). Conclusions Both approaches are minimally invasive, safe and effective for obese patients.TLH has the advantages of clear operative field, shorter operative duration and less blood loss, whereas the cost of TVH is less. Clinicians should take account of the patient′s condition, surgeon′s skill and surgical apparatus before choosing a surgical approach which is more safe and effective for patients.

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