To compare length of hospital stay for minilaparotomy vs laparoscopic hysterectomy. Retrospective cohort study (Canadian Task Force classification II-2). Kaiser Permanente Northern California, a large integrated health care delivery system. Women >18 years of age undergoing laparoscopic or minilaparotomy hysterectomy because of benign indications from June 2009 through January 2010. Hysterectomy via minilaparotomy or laparoscopy. Medical records were reviewed for outcomes of interest including length of stay and surgical and demographic data. Parametric and non-parametric analyses were used to compare the 2 groups. The study was powered to detect a difference of 8 hours in length of stay. Two hundred sixty-three cases were identified as hysterectomy via minilaparotomy (n = 100) or laparoscopy (n = 163). The laparoscopy group demonstrated a significantly shorter mean (SD) length of stay (19  hours vs. 42  hours; p < .001) and less blood loss (126  mL vs. 241  mL; p < .001). The minilaparotomy group experienced a shorter procedure time (113  minutes vs. 197  minutes; p < .001). There was no difference between the groups insofar as patient morbidity including intraoperative and postoperative complications, emergency visits, readmissions, or repeat operations. Compared with minilaparotomy, laparoscopic hysterectomy is associated with shorter length of hospital stay, longer operating time, and no increased patient morbidity.