Background: When hysterectomy is indicated for benign disease, there appears to be a general consensus in favor of the vaginal approach. However, it has been reported that the laparoscopic hysterectomy reduces postoperative complications and shortens hospital stay. The aim of this study was to compare complications and length of stay after vaginal vs. laparoscopic hysterectomy for benign disease in women treated at a tertiary care hospital in Southern Europe. Materials and Methods: This retrospective study included 573 women who underwent vaginal or laparoscopic hysterectomy for benign or premalignant disease between 2011 and 2015. The authors compared intraoperative, postoperative, and major complications, the duration of hospital stay, and the need for reoperation in the two groups. Results: The laparoscopic approach had a shorter hospital stays compared to vaginal hysterectomy, however it was associated with a higher risk of major complications (serious intra- and postoperative complications). Regarding total postoperative complications, there were no differences between the two approaches. Conclusions: Therefore the authors conclude that the approach of choice for hysterectomy indicated for benign disease should be the vaginal route for general gynecologists. The laparoscopic route is an alternative in women for whom the vaginal route is not feasible, and this approach should be performed by gynecological surgeons who have experience with this route.