In gynecologic surgery, hysterectomy is the most important procedure. Sometimes, however, hysterectomy can be a very difficult and challenging operation, and even more so if performed laparoscopically. Situations that distort the pelvic anatomy such as large fibroids, severe endometriosis, postoperative adhesions and morbid obesity make surgery much more difficult. Dr Lee analyses in a very didactic way all these situations, gives valuable directions and surgical strategies in order to overcome difficulties, and uses specific rules to obtain the best result as much safely as possible. Very useful are the different approaches, namely anterior, posterior and lateral, for patients with big fibroids, for adhesions and for fibrosis originating from severe endometriosis respectively.