Abstract Objective: To compare perioperative consequences including direct and indirect costs in patients with a bulky fibroid uterus sizing ≥ 12 weeks who underwent either Total vaginal hysterectomy (TVH) or who underwent total laparoscopic hysterectomy (TLH) for non-descent uteri. Patients and methods: A retrospective observational cohort study included 105 patients with a bulky fibroid uterus sizing ≥ 12 weeks who underwent hysterectomy (HR) performed between January 2015 and April 2023 in Benha university hospital and some private centers appraising the results between non-descent vaginal hysterectomy (NDVH) and TLH. The NDVH group consisted of 56 patients with a bulky fibroid uterus sizing ≥ 12 weeks who underwent TVH for non-descent uteri. The TLH group consisted of 49 patients with a bulky fibroid uterus sizing ≥ 12 weeks who underwent TLH for non-descent uteri. Both groups were compared statistically to discover variations in pre-, intra-, and post-operative demographic attributes as well as clinical measurements and perioperative consequences.Results: Both groups' participants were analogous as regards age, parity, pre-operative mean hemoglobin levels, hematocrit value, accompanying comorbidities, preceding CS numbers and parallel indications for hysterectomy, but greater arithmetic preoperative HBA1c and briefer preoperative hospital admittance (p < 0.0001) encouraging the NDVH group over the TLH group. There was no variance between the NDVH and the TLH clusters concerning operative time, blood loss, intra-operative complications, necessity for blood transfusion and rates of incidental cystotomy (p>0.05).