Background and Objective: Hysterectomy may be done for benign gynecological causes as uterine fibroids and abnormal uterine bleeding (AUB), pelvic organ prolapses, adenomyosis, endometriosis, cervical dysplasia, endometrial hyperplasia, or malignancy of genital tract. This work was aimed at comparing Total Laparoscopic Hysterectomy (TLH) with vaginal hysterectomy (VH) as the most effective approach for hysterectomy among women having benign uterine lesion with mobile non-prolapsed uterus of size not exceeding twelve weeks. Methods: our randomized controlled study involved 50 female cases whose ages were older than forty yrs, body mass index (BMI) 18.5-29.9 kgm2 suffering from benign uterine lesions requiring hysterectomy like fibroid uterus, adenomyosis or AUB, mobile non prolapsed uterus and uterine size not more than 12 weeks. Results: The mean operative time exhibited significantly lower values within VH group as opposed to TLH one (P=0.001). No statistically significant variation was documented regarding mean operative time as well as intraoperative blood loss amount among cases of TLH and VH group who had salpingo-oophorectomy and patients of TLH and VH group in whom salpingo oophorectomy was not done. Return to daily activity showed a significant difference between both groups as (P= 0.001). Conclusion: VH and TLH are feasible approaches for removal of mobile non prolapsed uterus with benign lesions. VH has the advantage of shorter operative time over TLH. Both should be used as alternative approaches for hysterectomy.