Even today, the most common treatment for symptomatic uterine fibroids continues to be hysterectomy. More recently, however, there has been renewed interest in removal of the myoma alone i.e., myomectomy. This is based in part on a desirable complication rate, necessity (delayed childbearing) and, in part, on choice; i.e., many women prefer the more conservative procedure myomectomy, to preserve the uterus. Uterine preservation has not only focused attention on myomectomy, but myolysis, cryomyolysis, embolization, laparoscopic uterine artery ligation, and MRgFUS. Early in his neophyte career, a medical student learns that the most common tumor of the female reproductive tract is the uterine leiomyoma. While it is generally stated that 20-30% of women over the age of 35 have at least one myoma, one study noted leiomyomata in 50% of females examined at time of autopsy. Quite likely, a genetic predisposition exists for myoma growth. Women of African descent have been noted to have 3-9 times greater risk of possessing uterine fibroids then Caucasians, who are more likely to have myomata than women of Asian ancestry. Although myomectomy via laparoscopy requires both skill and experience, it certainly must be considered a viable surgical procedure. In this chapter, the author will present his technique for laparoscopic myomectomy. Technical variations described by other physicians will be noted. Also included will be discussions on patient profile, preoperative workup, complication rate, risk of adhesion formation and subsequent pregnancy rate. Laparoscopic myomectomy has proven to be safe and cost-effective. Moreover, the advantages to the patient are obvious. Complications are low as is the subsequent adhesion rate. Moreover, pregnancy rates are consistent with myomectomy via laparotomy. Now the gynecologic endoscopist now has the instrumentation to allow a laparoscopic approach to myomectomy to be performed uneventfully in an outpatient arena.