Over the past decade, stunning advances in laparoscopy have fueled the enthusiasm of surgeons who use new minimally invasive methods for treating patients who have a variety of conditions. Laparoscopy avoids the obvious burden of a large abdominal incision that not only requires significant care but also involves increased disability, cost, and pain for the patient. Laparoscopy was introduced into gynecology in the United States in the late 1960s and slowly advanced from a diagnostic procedure to a technique for minor pelvic surgery and tubal sterilization. In the early 1970s, Professor Kurt Semm of Germany expanded the therapeutic applications of laparoscopy by performing oophorectomies, appendectomies, myomectomies, and extensive adhesiolysis.[1] However, his enthusiasm for advancing the use of this valuable tool was not immediately shared by other gynecologists. Laparoscopy, or pelviscopy as Semm called it, remained little used despite its demonstrated efficacy, safety, and acceptance by patients. Furthermore, the pelvic cavity remained the domain of the gynecologist and general surgeons paid little attention to their activities in this area.In 1974, we began using upper abdominal laparoscopy, albeit tentatively, in patients whose chronic right upper quadrant abdominal pain could not be thoroughly evaluated with the methods at hand.[2] When we found perihepatic adhesions, ie a Fitz-Hugh-Curtis Syndrome, the adhesions between the liver and abdominal walls were divided laparoscopically with complete resolution of symptoms. Shortly thereafter, Valle cautiously approached the retroperitoneal space opening the peritoneum and exploring the space (not previously approached by endoscopy) to remove translocated IUDs.[3] These early efforts established a foundation for later advanced laparoscopic operations, some of which required extensive retroperitoneal dissection.In the late 1970s, gynecologic laparoscopy was expanded with the introduction of video monitoring. The utilization of multiple monitors permitted the entire operating team to participate in the procedure and paved the way for development of new applications. Salpingostomy for treatment of tubal ectopic pregnancies, fimbrioplasty for bilateral tubal distal occlusion, and treatment schemes for extensive endometriosis were developed during this time.Laparoscopic cholecystectomy, reported on by general surgeons in the late 1980s, was a major catalyst that propelled the worldwide use of laparoscopy.[4] The acceptance of laparoscopic cholecystectomy was an important milestone as general surgeons soon began treating other abdominal conditions with laparoscopic methods that were previously managed only with laparotomy. These events stimulated gynecologists who were already familiar with laparoscopic procedures to broaden their endoscopic horizons. In 1989, Dr Harry Reich reported on laparoscopically assisted vaginal hysterectomy.[5] This procedure entered gynecological practice and has since developed multiple variations, depending on the extent of dissection required to remove the uterus and adnexa. Instrument manufacturers took note of the new changes in surgery and began to manufacture instrumentation to dissect, ligate, suture, and safely remove tissue. Task-specific instruments were developed, ie endoloops, suturing devices, tackers, staplers, and tissue morcellators for laparoscopic applications. Surgical procedures to treat urinary stress incontinence were adapted by gynecologists to be performed in a laparoscopic environment. Gastrointestinal surgery, including intestinal resection and anastomosis, was explored by general surgeons. Inguinal herniorrhaphy, Nissen fundoplication, splenectomy, diaphragmatic hernia repair, and nephrectomy were also approached endoscopically by different surgical specialists.The 1990s saw a flourishing of advanced laparoscopic techniques, and the learning process of surgeons, urologists, gynecologists, and other specialists began to be systematized. Proctoring, accreditation, credentialing, and standardization of the learning process were instituted and continue to evolve. Proper laparoscopic education and experience in residency training programs are closely monitored by the appropriate credentialing agencies.Few would deny that what was looked on as the distant future for endoscopic surgery just a few years ago has now arrived. As a new millennium begins, even greater advances can be predicted in the teaching, learning, application, and simplification of endoscopic methods. The trend to reduce, and perhaps totally replace, the need for large incisions in a patient's body has resulted in a reduction in morbidity, disability, pain, and cost. For those surgeons interested in applying technology to surgery, the future of minimally invasive methods is bright and full of promise.