The gynaecologists were the first to use minimal access surgery. This kind of surgery was, during years, limited to benign conditions. We were the first, in December 86, to use it in the management of cancer while performing a laparoscopic assessment of the pelvic lymph nodes for a woman affected by an infiltrative cervical cancer. We have now an experience of more than 400 cases. Pretherapeutic assessment of the retroperitoneal lymph nodes remains the best of the good indications of laparoscopy in the field of gynecologic oncology. Laparoscopy enables us to assess either the pelvic or the aortic retroperitoneal lymph nodes, using either the direct retroperitoneal approach or the transumbilical transperitoneal one. Many data clearly established that such an assessment is as reliable as the classical surgical assessment, while avoiding all the drawbacks of the open surgery. Knowledge of the lymphnodal status enables us to take at the good time (before radical surgery or radiotherapy) the good decision: in the good cases (no risk factor, no lymphnodal involvement) the treatment can be exclusively surgical and the surgery can be performed using the vaginal route: in the bad cases (risk factors and/or lymphnodal involvement) the treatment has to be multimodal using combinations (chemotherapy, radiotherapy, surgery) whose choice depends on the extend of the disease as it has been denned by the laparoscopy. The chosen example is representative regarding the role of minimal access surgery in oncology. The laparoscopie debulking surgery has been advocated by some surgeons in thoracic, abdominal and pelvic surgery. This practice appears as hazardous except, maybe, in the frame of neoadjuvant chemotherapy protocols during which a laparoscopie debulking of the residual masses can be undertaken. However the actual place of laparoscopie surgery is not here. Laparoscopy's first role is selecting the cases for an appropriate treatment. Minimal access surgery is a cost effective tool to use in order to improve the cost effectiveness of the treatment of pelvic, abdominal and thoracic cancer. The gynaecologists were the first to use minimal access surgery. This kind of surgery was, during years, limited to benign conditions. We were the first, in December 86, to use it in the management of cancer while performing a laparoscopic assessment of the pelvic lymph nodes for a woman affected by an infiltrative cervical cancer. We have now an experience of more than 400 cases. Pretherapeutic assessment of the retroperitoneal lymph nodes remains the best of the good indications of laparoscopy in the field of gynecologic oncology. Laparoscopy enables us to assess either the pelvic or the aortic retroperitoneal lymph nodes, using either the direct retroperitoneal approach or the transumbilical transperitoneal one. Many data clearly established that such an assessment is as reliable as the classical surgical assessment, while avoiding all the drawbacks of the open surgery. Knowledge of the lymphnodal status enables us to take at the good time (before radical surgery or radiotherapy) the good decision: in the good cases (no risk factor, no lymphnodal involvement) the treatment can be exclusively surgical and the surgery can be performed using the vaginal route: in the bad cases (risk factors and/or lymphnodal involvement) the treatment has to be multimodal using combinations (chemotherapy, radiotherapy, surgery) whose choice depends on the extend of the disease as it has been denned by the laparoscopy. The chosen example is representative regarding the role of minimal access surgery in oncology. The laparoscopie debulking surgery has been advocated by some surgeons in thoracic, abdominal and pelvic surgery. This practice appears as hazardous except, maybe, in the frame of neoadjuvant chemotherapy protocols during which a laparoscopie debulking of the residual masses can be undertaken. However the actual place of laparoscopie surgery is not here. Laparoscopy's first role is selecting the cases for an appropriate treatment. Minimal access surgery is a cost effective tool to use in order to improve the cost effectiveness of the treatment of pelvic, abdominal and thoracic cancer.