Following Caesarean section, hysterectomy is the second most common major gynecological surgery, with approximately 600,000 procedures performed annually in the USA. Since Reich et al. first reported a total laparoscopic hysterectomy (TLH) in 1989, numerous studies have confirmed its feasibility and reproducibility. Evidence increasingly supports TLH over vaginal hysterectomy (VH) and total abdominal hysterectomy (TAH) for benign gynecological conditions. The development and rapid advancement of laparoscopic instruments and techniques have enabled the safe and successful completion of complex procedures using minimally invasive approaches. Women with a higher BMI or requiring complex surgeries benefit from reduced postoperative complications with laparoscopic operations.

Inclusion Criteria:

• Patients aged between 35-60 years Patients presented with menometrorrhagia unresponsive to medical treatment, and uterine pathology such as adenomyosis or multiple fibroids.

Exclusion Criteria:

• Patients were excluded if they had: medical conditions preventing pneumo-peritoneum
• Patients with medical conditions hindering proper ventilation during general anesthesia.
• Patients diagnosed with endometrial carcinoma and patients with uterine size larger than 24 weeks were excluded.
• Patients with excessive adhesions precluding access to the uterine arteries were not enrolled in the study.