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.

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.

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.

Abdominal laparoscopy was first introduced by Kelling and Jacobaeus in the early 1910s and later by Palmer in the 1950s and 1960s.[1,2] Palmer noted that this new operative technique was superior to culdoscopy as there was a decreased chance of infection, better views of the pelvis, improved access to the pelvic organs and cul-de-sac, and easier application of surgical techniques.

This chapter presents a systematic approach to learning laparoscopic suturing and discusses technologies that aid in laparoscopic suturing. The foundation of the systematic approach to laparoscopic suturing depends upon an understanding of the geometric relationships between the anatomy, the instruments, the needle, the suture, and the camera. The system breaks the complex tasks of laparoscopic suturing and knot-tying into manageable parts but avoids oversimplification. The goal is to learn the proper mechanics of suturing and use those mechanics to reproduce efficient and accurate suturing.

Hysterectomy continues to be the most common gynecologic surgery in the US, as an estimated 600000 women undergo hysterectomy for benign indications each year. For women who require hysterectomy, the appropriate route of surgery is determined by anatomic considerations, the type of pathologic condition expected, patient preference, and physician experience and training. Since the first laparoscopic hysterectomy was performed by Reich in 1988, laparoscopic hysterectomy has emerged as an alternative to the traditional abdominal or vaginal hysterectomy.[1] In 1990, Nezhat et al. described the first laparoscopic hysterectomy performed with the GIA multifire stapler.[2] Minimally invasive approaches to hysterectomy have gained favor over the traditional abdominal approach because of their various benefits, which include decreased blood loss, less adhesion formation, fewer complications, shorter hospital stay, faster recovery, and improved cosmesis. Even some of the earliest studies regarding laparoscopic-assisted vaginal hysterectomy have shown favorable outcomes when compared to an abdominal approach.

The rapid co-evolution of instrumentation and surgical technique has allowed an ever-growing number of pediatric procedures to be performed using minimal access surgery (MAS). At present, any size or age patient (i.e., from fetus to adolescent) can benefit from MAS. Thoracoscopy and laparoscopy have many proven advantages when compared to open surgery including less postoperative pain, earlier return to normal activities, less risk of cosmetic and mechanical musculoskeletal deformities, possible less postoperative adhesive disease, and in many cases better exposure and magnification of the operative field. Given these potential benefits, MAS has been increasingly adopted by pediatric surgeons as the preferred approach for management of many surgical diseases in children and infants.