One example of this evolution is the treatment of the ectopic pregnancy. 60 years ago significative number of these patients didn’t survived due to huge haemorrhages. Since 1970 the progress was laparoscopic treatment initiate by M.-A. Bruhat et al which permit a conservative treatment of the tubes. And finally and the end of the century metothrexate injection has suppressed the surgery and have replaced more and more the surgical treatment.

Today a lot of patient and gynaecologist take care to prevent tubal infection and then prevent ectopic pregnancy. By means of these attitudes we started the translation from curative medicine to preventive medicine. This attitude has permitted to reduce the incidence of ectopic pregnancy. The more recent progresses in gynaecological surgery are represented by the robotic and the natural orifice access.(NOTES). Despite tremendous efforts of the Industry, these techniques are still not competitive with laparoscopic surgery for patient benefit and costs effectiveness.

The last possible progress actually is probably the education of the surgeons and the possibilities of computer stimulation before surgery are probably the most exciting solution to improve and control the surgeons skillness.. However the key question for the young gynaecologist today is to invest himself in surgical education or not because after the progress in preventive Medicine and the progress in predictive medicine the indication for surgery are less and less. The example is the new vaccine against HPV infection which will be probably suppressed completely any surgery of the low genital track in the Future. Another one is the development of the selective progestative receptor modulator which will suppressed probably the fibroids development

In conclusion last century was the one of progress in minimal invasive surgery thanks to endoscopic techniques but the number of indications for surgery is falling down……… No further progress can be actually expected, excepting for training of the future surgeon through the computer simulation system. Surgery will remain mandatory to remove masses and acute situation like appendicitis, endometriosis ileus. But the development of preventive and further the predictive medicine are already effective and better for patients and invite us to work to suppress surgery.