The senior author has had the privilege, along with almost 2,000 other delegates, of visiting the extraordinary ESGE meeting in Florence recently. The size of the turnout suggests that there is much going well in the field of gynaecological surgery. Minimal access techniques are now being used in every inhabited continent and in every type of health care system. There are more and more doctors of every nationality, colour and religion coming together with the single aim of improving the outcomes of surgical interventions in women. Reviewing the more than 400 talks, videos and posters presented at the ESGE meeting clearly demonstrates how minimal access techniques may be used for virtual every surgical intervention in gynaecology. We were also privileged to see enormous trade exhibitions with literally hundreds of new refined tools and devices, all designed to make surgically easier, more acceptable and above all safer for our patients. Whilst self-evidently good, this excess of technological virtuosity brings with it major concerns. The very number and variety of these advanced technologies can, in fact, be rather overwhelming. Many of these devices are extraordinarily expensive and in these difficult financial times it is ethically essential that, irrespective of the type of health care system in which we practice, we develop systems that not only work but work cost-effectively. With this concept in mind, we present here our personal review of some of the presentations from this important meeting. 1. Improved imaging techniques. From the first video laparoscopies, there has been a steady and dramatic improvement in the quality of the images we have. Better light sources and cameras have replaced dull, poorly illuminated pictures by images of consistent high quality. Three-chip cameras are now standard and increasingly high-definition systems are becoming available. The results of these technological advances were demonstrated by the extraordinary quality of many of the videos shown throughout the meeting. This is an area which is perhaps difficult to justify on formal cost effect analysis but in which there can be no compromise. To undertake surgery with inadequate vision is both impractical and unethical. Conversely, the better the image available, the better the definition of the anatomy and pathology and so the more precise and better the quality of the surgery should be. The images are now so good it is difficult to anticipate further meaningful improvements but it is probable that further miniaturisation will make the instruments easier to use, particularly in areas currently difficult to access. Three-dimensional imaging would also simplify dissection and suturing. Such systems have been tried previously but have been found to be heavy and difficult to use and to also produce unstable and nausea-producing images. It is likely that improvements in these systems may soon result in the wide availability of useful 3-D imaging systems. 2. Entry techniques. From the earliest days of laparoscopic surgery the safest and best method of entry into the abdominal cavity has been a matter of controversy. The data has been recently reviewed and extensively commented on in this journal (Sutton). Because of the relative infrequency of serious entry-related injury it has not been possible to do large enough trials to prove R. Garry (*) 94 Westgate, Guisborough TS14 6AP, UK e-mail: raygarry@btinternet.com