Background: Total laparoscopic hysterectomy (TLH) has become a widely adopted approach for the removal of the uterus due to its minimally invasive nature, reduced postoperative pain, shorter hospital stays, and quicker recovery times. This study aimed to compare the efficacy and safety of unidirectional and bidirectional barbed sutures for vaginal cuff closure during total laparoscopic hysterectomy (TLH) in terms of operative time, intraoperative blood loss, postoperative pain, and recovery time.Materials and Methods: This prospective, randomized controlled trial was conducted at a tertiary care hospital, enrolling 80 patients undergoing TLH for benign gynecological conditions. Patients were randomly assigned to either the unidirectional suture group (Group A, n = 40) or the bidirectional suture group (Group B, n = 40). The vaginal cuff was closed intracorporeally using barbed sutures in a continuous running manner. The primary outcome was vaginal cuff closure time. Secondary outcomes included intraoperative blood loss, postoperative pain at 6, 24, and 48 hours, suture-related complications, and time to return to normal activity. Data were analyzed using appropriate statistical tests, with a p-value <0.05 considered significant.Results: Baseline characteristics were similar between the two groups. Vaginal cuff closure time was significantly shorter in Group B (10.20 ± 2.10 minutes) than in Group A (12.50 ± 2.30 minutes; p = 0.001). Intraoperative blood loss was lower in Group B (47.80 ± 9.70 mL) compared to Group A (55.30 ± 10.50 mL; p = 0.007). Postoperative pain scores at 6 and 24 hours were significantly lower in Group B (p = 0.045 and p = 0.020, respectively), while no significant difference was observed at 48 hours (p = 0.150). Suture-related complications, including dehiscence, granulation, and infection, were comparable between both groups. Patients in Group B resumed normal activities earlier (9.00 ± 2.50 days) compared to Group A (10.20 ± 2.80 days; p = 0.030).Conclusion: Bidirectional barbed sutures demonstrated superior efficacy compared to unidirectional sutures in vaginal cuff closure during TLH, with significantly shorter closure time, reduced intraoperative blood loss, and faster postoperative recovery. Both techniques had comparable safety profiles. These findings support the preference for bidirectional sutures to improve surgical efficiency and patient outcomes.