Endometriosis is classically defined as the presence of endometrial glands and stroma in ectopic locations. Affecting 6–10% of reproductive-aged women, endometriosis can result in dysmenorrhea, dyspareunia, chronic pelvic pain, and/or subfertility.[1,2] The prevalence of this condition in women experiencing pain, infertility, or both is as high as 50%. Endometriosis is a debilitating condition, posing quality-of-life (QOL) issues for the individual patient.[3] The disorder represents a major cause of gynecologic hospitalization in the US, estimated to have exceeded $69 billion in healthcare costs for diagnosis and treatment and improving QOL in 2009.[4] The significant individual and public health concerns associated with endometriosis underscore the importance of understanding its pathogenesis. The first recorded description of pathology consistent with endometriosis was provided by Shroen in 1690.[5] Despite the passage of time and extensive investigation, the exact pathogenesis of this enigmatic disorder remains unknown, although about 50% of risk of developing endometriosis is due to genetic factors and 50% to environmental factors.

In order to enhance training, improve patient safety, and reduce the complication rate associated with minimally invasive surgery, surgical simulators have been incorporated into training curricula and skills courses. This chapter provides an overview of the development of simulation devices. Important concepts in simulation training are explained including validation and fidelity. We discuss the advantages and disadvantages and compare the different types of simulators available for laparoscopic and robotic-assisted platforms. The integration of simulators in residency and fellowship training is presented. It is important to emphasize that currently surgical simulation is merely an adjunct to, and not a replacement for, other traditional methods of training, including supervision, mentorship, feedback, and operative experience.

The majority of surgical and medical conditions diagnosed in utero are best managed after delivery. There is a finite list of conditions that when diagnosed antenatally result in death or long-standing morbidity. This raises the possibility that treatment may be best approached prenatally. Almost 30 years ago, the International Fetal Medicine & Surgery Society (IFMSS) developed the criteria for fetal surgery. The criteria as written at that time included an accurate diagnosis, a known natural history of the disease, no available effective postnatal therapy, proven efficacy of a prenatal intervention, and the requirement that interventions for the fetus would be performed in a specialized multidisciplinary center.[1] Fetal therapy has expanded since then to treat nonlethal conditions so as to reduce long-term morbidity.

The following account of telepresence surgery is the collective perspective of a few individuals who witnessed and participated in its development from initial inception at the Stanford Research Institute (SRI) to commercialization at Intuitive Surgical as the da Vinci® system. It should be noted that there are several differing accounts of the history of telepresence surgery, and while there are factual elements in each version, none of the accounts to date has benefited from the perspective of the team that spanned the early days of the development of telepresence surgery at SRI to the early days of development of da Vinci at Intuitive Surgical.

The first vaginal approach (minimally invasive) to the surgical management of female stress urinary incontinence (SUI) was described by Howard Kelly in 1913. He described an anterior horizontal mattress plication stitch placed at the urethrovesical junction (UVJ) designed to narrow the proximal urethra and provide elevation of the bladder neck.[1] Although this original procedure did provide symptomatic relief in many patients, several studies have demonstrated an unacceptable failure rate over time.

Patient positioning and operating room (OR) setup are vital steps in preparation for any surgical procedure. This chapter reviews proper patient positioning along with some of the complications that can occur from improper positioning. This chapter also discusses the proper and efficient operating room setup to allow for optimal utilization of OR space.

The reproductive and urinary tracts in women are closely related anatomically and because of this proximity, pathogenesis or diagnosis of gynecologic conditions may need evaluation of the urinary tract. Cystoscopy is an endoscopic technique for examining the internal aspect of the bladder. It is the principal way to diagnose and survey bladder conditions.

The field of reproductive medicine is evolving rapidly. We are living in an era in which what was seemingly impossible a decade ago is being made possible, and century-old dogmas are being challenged. Thanks to new cryopreservation technologies, infertility and premature ovarian failure, especially when induced by medical treatments, are no longer unavoidable consequences. Whereas success with oocyte cryopreservation is now an acceptable and successful approach for use in patients who face the risk of ovarian failure due to medical treatments or to create “egg banks” for oocyte donation, ovarian tissue cryopreservation and transplantation have only recently been accepted as a nonexperimental way to reverse menopause and restore fertility. Recent advances in in-vitro maturation, stem cell and gene editing technologies, coupled with the advances in fertility preservation, point to a promising future in Reproductive Surgery and Medicine.

Approximately 40–90% of females have painful menses or dysmenorrhea.[1] Dysmenorrhea can be categorized as primary or secondary depending on the onset of symptoms. With onset just after menarche, primary dysmenorrhea is defined as menstrual pain without pelvic pathology. Secondary dysmenorrhea is characterized by an underlying pathology and can present any time after menarche. Dysmenorrhea often presents with both somatic complaints and mood/behavioral changes.

Hysteroscopy is an essential diagnostic and operative modality in gynecologic surgery. Direct visualization of the endometrial cavity allows surgeons to identify, diagnose, and treat a wide array of pathology. This chapter seeks to cover the basics of this surgical method as well as the recognition and management of complications that may be encountered.

Since the introduction of laparoscopic surgery in the early 1900s, traditional surgeons have met it with skepticism. However, after decades of modern advances in technology, including improved lens systems, cold light, fiber optics, and especially the development of video endoscopy by Dr. Camran Nezhat, combined with the pioneering work of the early gynecologic surgeons, minimally invasive video laparoscopy and robotics have made inroads into the diagnosis and treatment of gynecologic oncology.[1,2] The first video laparoscopic radical hysterectomy, para-aortic and pelvic lymphadenectomy, was performed by the Nezhats in 1989 and reported in subsequent years.