Design: The patient was counseled and desired definitive management via hysterectomy.

Setting: Four trocars with monopolar and bipolar electrocautery as well as laparoscopic suturing were used.

Patients or Participants: One patient case is illustrated in this video.

Interventions: Total laparoscopic hysterectomy, bilateral salpingectomy, ureterolysis, and cystoscopy.

Measurements and Main Results: Total surgical time was 3.5 hours. Estimated blood loss was 100mL. The patient was eligible for discharge same day but discharged on post-op day 1 due to insurance status.

Conclusion: Laparoscopic hysterectomy in the setting of a large posterior fibroid can be accomplished safely by utilizing the techniques of ureterolysis, ligation of the uterine artery at its origin, and using vaginal retractors to identify the location of the colpotomy without a colpotomy cup.