In the last decade, laparoscopic surgery had become popular in gynaecological surgery. Advantages of the minimally invasive approach are reduced postoperative morbidity, less postoperative pain and, consequently, less analgesic requirement, early resumption of intestinal activity and reduced length of hospital stay. Ectopic pregnancy occurs in approximately 1–2% of pregnancies and the incidence is increasing. The most common site of ectopic pregnancy is the ampullary tubal portion and less frequently other parts of the tube and uterus (cornual and caesarean scar pregnancy), the cervix, the ovary and the abdominal cavity are affected. All variants of extrauterine pregnancy can be treated by a minimally invasive approach in the majority of cases. Moreover, minimally invasive surgery can be considered the standard therapeutic option for adnexal masses which represent one of the most common gynaecological diseases. In this chapter, we describe the main surgical techniques concerning these two pathologies, which are of great interest for daily gynaecological practice.

A 28-year-old nulligravid woman presents reporting severe dysmenorrhea, deep dyspareunia, and dyschezia that worsens with menses. She states she has always had painful periods, but they have worsened over the past year. She describes it as sharp, twisting, and feels that something is “stabbing her from the inside out.” She is in a long-term relationship and desires future fertility. She has tried several different combined oral contraceptive pills, which mildly improved her pain. She has also tried non-steroidal anti-inflammatory drugs, medroxyprogesterone acetate, and a gonadotropin-releasing hormone agonist without relief. She states the dyspareunia and constipation have worsened over time. She underwent a diagnostic laparoscopy at age 26 and was told she had stage IV endometriosis. She continues to have debilitating pain that significantly impacts her quality of life. She would like to proceed with fertility-sparing surgical management. She has no other relevant relevant past medical or surgical history. She is currently taking oral contraceptives (ethinyl estradiol/norethindrone) and has no known drug allergies.

A 24-year-old female, gravida 0, presents to the office for follow-up of suspected endometriosis. Her last menstrual period started two days ago. She reports a three-year history of chronic pelvic pain that is worse during menses, is moderate to severe in intensity, and crampy in nature. She has tried combined oral contraceptive pills without symptomatic improvement. She denies fever, changes in bowel or bladder habits, or dyspareunia. She is sexually active with one male partner. She uses condoms regularly. She has no history of sexually transmitted infections. She has no significant past medical or surgical history.

A 16-year-old nulligravid female presents to the emergency department with abdominal pain. She reports the pain started suddenly two hours prior to arrival and is associated with nausea and vomiting. The pain comes and goes, is located in the right lower quadrant, and is described as sharp and stabbing. She rates the pain as nine out of ten. She denies fever, chills, urinary symptoms, diarrhea, and constipation. She reports never having been sexually active. She has no past medical or surgical history. She is not taking any medications and she has no known drug allergies.

A 34-year-old gravida 3, para 3 is undergoing an interval bilateral salpingectomy for permanent sterilization. She is currently using combined oral contraceptive pills (containing ethinyl estradiol/norethindrone) for contraception. Because of side effects associated with the pill, she has opted for permanent sterilization. She understands sterilization is a permanent procedure and is certain she has completed her family. Her pre-procedure pregnancy test was negative. All her deliveries were spontaneous vaginal deliveries. She has no history of easy bleeding or bruising. She has no past medical or surgical history. She is not taking any other medications and she has no known drug allergies.

A 40-year-old woman, gravida 3, para 3, with last menstrual period two weeks ago presents for evaluation of a palpable pelvic mass. She reports noticing a slow increase in her abdominal distention over the last four months; however, she denies abdominal pain. She denies any bowel or bladder dysfunction. She is sexually active and denies dyspareunia. Her sexual partner has had a vasectomy. She denies a personal history of breast cancer and denies any family history of breast, ovarian, or colon cancer. Her medical history is significant for anxiety. She has no past surgical history. She is currently taking citalopram. She has no know drug allergies.

Laparoscopic extensive myomectomy, hysterectomy for large myomas, laparoscopic treatment of endometriosis or treatment of cancer of the uterus are advanced laparoscopic gynaecological procedures. Since they can be very challenging, many special pre-, intra- and postoperative aspects need to be considered. This chapter aims to give insights into the different advanced laparoscopic gynaecological procedures. The preoperative arrangement, the intraoperative setting, key operative steps and the postoperative course are described in detail. An overview of common intraoperative complications like ureter injuries, bladder injuries, gastrointestinal injuries, vascular injuries and pneumoperitoneum-linked complications is given. Some typical postoperative complications like wound-healing problems, bleeding and gastrointestinal lesions are described together with possible treatment options.

Endometriosis is a chronic oestrogen-dependent condition that affects 10% of women from puberty to menopause. It is characterised by the presence and proliferation of endometrial-like cells outside the uterine cavity, generally within the pelvis. Endometriosis can present as superficial or deep peritoneal lesions, ovarian endometrioma or deep rectovaginal disease. The two hallmark symptoms of endometriosis are pelvic pain and infertility resulting in poor quality of life. There is no correlation between the extent of the disease and severity of symptoms. The true prevalence of the condition is not known, as it requires a laparoscopy to confirm the diagnosis. It is found in up to 30% of women with infertility and in 45% of those with pelvic pain. While there are several theories of pathogenesis, an interplay of genetic, hormonal, environmental and immunological factors is implicated in the development of endometriosis in susceptible women. Symptoms are managed with a combination of hormonal treatment and laparoscopic ablation or excision of lesions for pain and usually assisted reproduction for infertility. Endometriosis is prone to recurrence after treatment, requiring multiple contacts with healthcare and repeat surgery. Management of endometriosis requires an individualised approach based on the woman’s age, predominant symptoms and priorities, which are subject to change over time.