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Objective: The objective of this study was to investigate the association between obesity and intra/post–operative complications of total laparoscopic hysterectomy (TLH). Materials and Methods: This retrospective cohort study included 21,356 patients who underwent TLH and who were included in the National Surgical Quality Improvement Program database in 2016. Body mass index (BMI) was stratified according to the World Health Organization classifications (normal: 18.5–24.9 kg/m2; overweight: 25.0–29.9 kg/m2; obese I: 30–34.9 kg/m2; obese II: 35–39.9 kg/m2; obese III: ≥40 kg/m2). The primary outcome was the presence of intra/post–operative complications. Unadjusted and adjusted binary logistic regression was used to calculate odds ratios (ORs) and the corresponding 95% confidence intervals (CIs). Results: There was a statistically significant decrease in odds of complications in Obese I compared with normal weight (OR: 0.8; 95% CI 0.7–0.9). The subpopulations with increased odds of complications included postmenopausal patients (OR: 1.3; 95% CI 1.1–1.4); black patients (OR: 1.4; 95% CI 1.2–1.6); or patients with chronic hypertension (OR: 1.3; 95% CI 1.2–1.5), chronic obstructive pulmonary disease (OR: 1.9; 95% CI 1.3–2.8), disseminated cancer (OR: 2.8; 95% CI 1.8–4.2), and/or bleeding disorders (OR: 4.2; 95% CI 3.0–5.9). Conclusions: While obesity is a risk factor for developing comorbidities and increased surgical morbidity, it appears that a moderately high BMI may be protective in recovery. These findings support the "obesity paradox," suggesting a counterintuitive benefit of adipose tissue when undergoing physiologic stress. [ABSTRACT FROM AUTHOR]