A literature search was performed to find evidence-based practices that aid in the preoperative evaluation, intraoperative techniques, and postoperative management of the obese patient requiring hysterectomy. Complications are more frequent than in normal weight patients and are more difficult to manage. Few studies provide direct evidence with which to help guide surgical decision-making and postoperative management. However, there is sufficient evidence to support that when feasible, the vaginal route is preferable in obese patients. Techniques validated for normal weight patients like antibiotic and thromboembolism prophylaxis seem effective in obese patients, and are likely even more important.