This review covers state-of-the-art technologies for advanced anaerobic digestion of municipal sewage sludge. It is based on an extensive review of literature and available data, focussing on processes which have been realized in full-scale plants. The review includes information on single-stage mesophilic digestion, thermophilic digestion, temperature-phased digestion, high-load digestion and other process modifications, as well as mechanical, thermal, chemical, and biological disintegration methods. All processes are described with a set of key performance indicators such as degradation rate of volatile solids, biogas yield, return load, effects on dewatering, and capital costs.