Women with uterine fibroids are more likely to have pregnancies complicated by fetal and maternal complications. Women should be counselled that the risks of obstetrical complications are increased with the presence of fibroids in pregnancy. There are still no adequate data on the optimum management strategy of fibroids in pregnancy. In women with prior myomectomy, a plan for labour and vaginal delivery is reasonable in those who did not have extensive myometrial dissection or entry into the endometrial cavity. Alternately, for those who choose an approach of scheduled Caesarean delivery, timing at 37–38 weeks’ gestation is reasonable.

Uterine leiomyomas or fibroids are common benign tumours of the uterus. Myomectomy is performed via laparoscopy, laparotomy or hysteroscopy depending on the location of the myoma, the size and the symptoms. Before myomectomy, the patient must be informed of the risk to undergo conversion of the surgical techniques as well as about myoma recurrence. Administration of a GnRH agonist for 4 months before myomectomy improves pre and postoperative haemoglobin levels and reduces the size of the myoma. In the case of submucosal myomas of FIGO type 0, 1 and 2, which are <4 cm in diameter, hysteroscopic myomectomy is the preferred approach and significantly improves pregnancy rates. The laparoscopic approach is feasible when the number of fibroids is low, and they have a small diameter.

A 40-year-old female, gravida 1, para 1, presents to the office with complaints of heavier, longer menstrual cycles and intermenstrual spotting. Her cycles were previously every 28 days, lasting 4 days, and using 3–4 pads per day. Now, her cycles are lasting 9–10 days, and she is soaking 8–9 pads on her heaviest day. She has spotting 2–3 days every week. She reports mild cramping but denies urinary or bowel complaints, dizziness, or weakness. She has had one prior normal pregnancy with spontaneous vaginal delivery, and she has been trying unsuccessfully to conceive for the past year. She has no significant past medical or surgical history, she is taking only prenatal vitamins, and she has no known drug allergies.

Laparoscopic extensive myomectomy, hysterectomy for large myomas, laparoscopic treatment of endometriosis or treatment of cancer of the uterus are advanced laparoscopic gynaecological procedures. Since they can be very challenging, many special pre-, intra- and postoperative aspects need to be considered. This chapter aims to give insights into the different advanced laparoscopic gynaecological procedures. The preoperative arrangement, the intraoperative setting, key operative steps and the postoperative course are described in detail. An overview of common intraoperative complications like ureter injuries, bladder injuries, gastrointestinal injuries, vascular injuries and pneumoperitoneum-linked complications is given. Some typical postoperative complications like wound-healing problems, bleeding and gastrointestinal lesions are described together with possible treatment options.