Background: Ectopic pregnancy rarely occurs in the uterine cornu. When it does, it exposes the affected patient to the risk of death from rupture with intra-abdominal bleeding. Its surgical management is difficult. The primary modalities for treating this condition are surgery in the form of laparotomy and methotrexate administration. They both have advantages and potential shortcomings. An alternative option is operative laparoscopy, which may be preferable to these other approaches under certain circumstances. Cases: Three cases of women with unruptured cornual ectopic pregnancies that were managed by operative laparoscopy, are reported. All pregnancies were advanced, with large cornual masses and high beta-subunit hCG levels. The operative procedure involved use of an endo-GIA (Tyco U.S. Surgical, Norwalk, CT), cautery, endoclips, and Surgicel ( Johnson & Johnson Medical, Inc, Arlington, TX). It was completed without complications. Blood loss was not excessive. Operative time was somewhat prolonged, probably reflecting a long learning curve for this technique. Conclusions: Operative laparoscopy was found to be feasible and safe as a potentially utilitarian alternative to laparotomy or conservative medical management for advanced unruptured cornual pregnancies. It may benefit selected patients whose cardiovascular status is stable and whose advanced cornual pregnancy has not yet ruptured. ( J GYNECOL SURG 27:155)