Progress is evident in the whole concept of breast cancer treatment and in the assessment of the sentinel node in different cancers of the female in urogynecology, as well as in minimally invasive surgery. In this review we concentrate on the impact of endoscopic surgery. Minimally invasive surgery has evolved in a relatively short period of time to overtake the centuries old visionary and pioneering groundwork of outstanding colleagues in all surgical disciplines. This overview on the development of gynecological surgery highlights past achievements and describes present challenges of endoscopic surgery. It emphasizes future opportunities and possibilities to foster interdisciplinary collaboration and integrate emerging endoscopic, imaging and stereotactic surgical technologies to improve patient safety, enhance quality of care and advance surgical education.