Obesity is a challenging health problem that affects surgical decision-making. Obesity has also been associated with an increase in the perioperative complication rate in open abdominal hysterectomy and can increase the level of difficulty in performing a vaginal hysterectomy. Total laparoscopic hysterectomy (TLH) is a route that can offer advantages in obese patients including smaller incisions that are less likely to become infected as well as less post-operative pain and good visualization. With appropriate perioperative planning and techniques, excellent outcomes can be achieved.