Laparoscopic myomectomy is a very recent advance in the field of gynaecological surgery. It requires proper patient selection, meticulous technique, manual dexterity and experience in laparoscopic suturing skills. If strict criteria are used laparoscopic myomectomy is as effective as abdominal myomectomy. The procedure should involve multilayered uterine closure to avoid a weaker scar and subsequent rupture. Women with diffuse and large leiomyomatous uterus are best treated with conventional laparotomy. The safety and efficacy of newer procedures including myoma coagulation and cryosurgery needs to be determined. For women with completed family hysterectomy should be offered. Women with sub mucous myomas are best treated by hysteroscopic myomectomy.