This video demonstrates a uterine sparing excision of a 10.8cm x 9.7cm anterior wall adenomyoma with a strengthening triple flap closure of the myometrium.  The patient was a 36year old P0+3, who had suffered one first trimester and two second trimester pregnancy losses.  An 8cm longitudinal incision was made on the fundo-anterior surface of the uterus.  The depth of the incision was carefully assessed by introducing a small flexible ruler into the peritoneal cavity. A 1cm margin of myometrium was left circumferentially around the excised adenomyoma, and at the internal margin of dissection next the endometrial cavity to preserve uterine function and minimise risk of breaching the endometrial cavity.  The adenomyoma was then dissected out, within these margins and to the predetermined depth, en bloc, with a cold laparoscopic knife.  The depth of excision was checked again after excision was complete.  A hysteroscope was passed as an aid to dissection, to delineate depth of dissection; by periodically turning off the laparoscope light, to all the glow from the cavity to be seen.  The uterine wall remaining was bisected on one side, to allow for a triple flap closure of the defect.  Initial deep sutures were placed to obliterate dead space, before the two transverse flaps were opposed in an overlapping nature, in a transverse orientation.  These two closed flaps were then covered by the remaining half of the uterine wall in a longitudinal plane.  Surgical operating time was three hours twenty minutes.  Estimated blood loss was 100ml.  The theoretical, potential benefit of this approach to closure is the increased density of the myometrium overlying the uterine defect, and the spread of tension across multiple suture lines, possibly, increasing the uterine wall tensile strength during any subsequent pregnancy achieved.