Twenty-two consecutive patients weighing 100 kg or more and requiring hysterectomy were treated by laparoscopic assisted vaginal hysterectomy. The mean patient weight was 105.2 kg. In 21 patients, the indication for hysterectomy was menorrhagia (9 of these had uterine fibroids) and one patient had microinvasive carcinoma of the cervix. Mean operating time was 1 hr. 53 mins; and mean hospital stay was 4.5 days. One patient (4.5%) had intraoperative injury to the interior epigastric vessels. One patient who had anterior colporrhaphy at the same time suffered transient urinary retention which resolved after one week. There were no major or long term complications. Our experience suggests that laparoscopic assisted vaginal hysterectomy is a feasible and safe option in obese patients. The low complication rate may be due, in part, to improved access through the use of this approach.