Over the past few years, access to various body parts through tiny incisions, has revolutionized the practice of surgery. Proclaimed advantages of minimal access surgery (MAS) such as, diminished post-operative pain, hospital stay and earlier return to work have been documented. It was a question of time before the aorta and the iliac arteries became a target for the laparoscope. Actually, which group of patients could benefit more from the proposed advantages of MAS than the often high risk candidates to vascular reconstruction? Over the same period, vascular surgeons and general surgeons performing vascular surgery faced other challenges. The following lines intend to give the surgeon matter for reflection on the not so distant major transformations which could influence the vascular field and the surgeon’s professional life. Although the current training requirements as defined by the Accreditation Council for Graduate Medical Education [52] assure that the trainee will have adequate preparation to practice vascular surgery, it does not describe the additional preparation required to make that trainee a competent vascular surgeon in the sense that he or she would also be a complete ‘‘vascular specialist’’ [18]. In particular he or she should have the capability of prescribing or performing all possible means of treating the disease that is found. These treatments presently include conservative noninterventional treatment, medical therapy with pharmaceuticals, catheter-directed endovascular treatments, and operative treatment [18]. Although the number of major abdominal aortic surgical procedures remained comparable in the USA from 1987 to 1992 (aortic aneurysm repairs: 45,000; aortoiliofemoral bypasses: 31,000), Stanley et al. conclude that the increasing incidence of vascular disease in an expanding elderly population supports a continuing need for vascular surgery specialists. However, they add that new health care delivery systems and evolving technology may lessen the need for surgical care of these patients [53]. Certain calculations of future workforce needs in that report are based on the assumption that current indications for the various operations and their utilization rates will remain relatively stable. Managed care and capitation provide strong financial incentives to curtail costly procedures, including vascular operations. This will be particularly true when the published data document only marginal differences between benefit and cost. Undoubtedly, this approach will affect the performance of carotid endarterectomy, aortic aneurysmectomy, and extremity bypasses. Should this scenario occur, and given existing political and socioeconomic maneuvering such is likely, it will have a significant impact on workforce needs [53]. Reliable data point to the fact that by the year 2000, there will be an excess of 120,000 to 150,000 medical specialists in the U.S. [36]. Endovascular techniques (percutaneous transluminal angioplasty (PTA), lytic agents, catheter aspiration thromboembolectomy, caval filters, coil embolization) have not yet had an overwhelming effect on the practice of vascular surgery, having replaced, at most, approximately 15% of all vascular operations [27, 53, 60]. Only short stenotic lesions causing minor symptoms have responded well to PTA [29]. Also, <20% of lower limb salvage surgical candidates are amenable to treatment by PTA alone [58, 59]. Endovascular stents and, more importantly, stented grafts may significantly change this state of affairs [60]. Stents could replace another 15% of open vascular operations and endovascular grafts 20% to 40%. This means that from 45% to 65% of major operations could be performed by an endovascular surgical technique [27, 60]. According to many, the choices Correspondence to: Yves-Marie Dion Surgical Endoscopy