Laparoscopic myomectomy cases are mostly doable, but may become difficult if bleeding problems occur. Extended operative times may be required for morcellation and extensive laparoscopic suturing. Gynecologists need to improve their laparoscopic skills, as minimally invasive surgery is becoming the sine qua non of a modern surgeon.

Uterine fibroids are remarkably common and may rarely grow to a large volume. The standard treatment in this situation is abdominal hysterectomy. We are presenting the case of a large multiple fibroid uterus that was successfully treated with total laparoscopic hysterectomy and the problems associated with such an operation.

Laparoscopic myomectomy is a safe procedure in the hands of an experienced advanced laparoscopic surgeon. Blood loss is dependent on the myoma size and bleeding is the most serious intraoperative complication which may require performing a staged laparoscopic myomectomy, conversion to open myomectomy or blood transfusion. Maintaining homeostasis is the chief requirement to successfully and uneventfully complete the procedure without conversion to the open route.

Frequently, a fixed pelvis is encountered that is caused by a benign disease, either severe endometriosis or severe adhesions with or without fibroid uterus. We present two cases of nulligravida and multiparous women who had absolute frozen pelvises with no motion whatsoever of their pelvic structures on bimanual examination. Conventionally, these patients would have been approached by open hysterectomy only. We do not consider a frozen pelvis from what appears to be a benign case a contraindication to the laparoscopic approach.

Dyspareunia frequently has a multifactorial aetiology. The problem with the term is that it is not specific enough and does not allow for proper discussion of the very important problem of pain with sexual intercourse, a problem that can be very disturbing to a couple's relationship. We present two cases of patients who had multiple potential anatomic reasons for dyspareunia. The clinical picture, treatment strategy and the complex nature of deep penetration pain was discussed. We also proposed a new way of defining dyspareunia to allow a more adequate way of studying and discussing the problem.