This video shows a Difficult Total Laparoscopic Hysterectomy performed by Dr. R.K. Mishra at World Laparoscopy Hospital. The level of difficulty of various types of hysterectomy differs and may influence the choice of either approach. When surgeons consider one specific approach to hysterectomy as more difficult, they may be reluctant to perform this type of hysterectomy. The main objective of this video was to investigate the potential different levels of difficulty for laparoscopic hysterectomy.  Several factors may influence the estimated level of difficulty of total laparoscopic hysterectomy: uterine size on bimanual palpation, presence of fibroid, patients’ weight and BMI, previous abdominal surgery and surgeon’s experience with the planned approach to hysterectomy.