Over many years, newer and sophisticated techniques have been implemented in minimal-access surgery. In experienced hands, its quality has become comparable to other methods, eventually being even superior in many instances. It is now important to reevaluate the concomitant risks to continuously avoid or at least reduce complications.

In this issue, many experts in gynecological minimal-access surgery have openly discussed not only the benefits but also the possible negative effects of the performed techniques. All surgeons, experienced and aspiring, should bear in mind that they significantly influence the quality of the patient’s life. Lefebvre et al. reveal the weaknesses of present-day resident teaching and suggest a hands-on mentor program. Nezhat et al. suggest learning using robotic-assisted laparoscopy. Magrina et al. and Herrmann et al. highlight, respectively, the impact of trocar-induced and adhesion-provoked risks before surgery. First, trocar entry injuries with possible significant morbidity or mortality are discussed and evaluated. Adhesion-induced impact can be reduced by adhesion-preventing standards that can be applied to every gynecological surgery. Oliveira et al. document the problems encountered during surgery and subsequent repair, such as deep bowel-infiltrating endometriosis. Tulandi et al. show the benefits and drawbacks of conservative uterine myoma surgery, and Krentel et al. in laparoscopic supracervical hysterectomy.

These risks of occult malignancy spreading during power morcellation are highlighted. The risk of tissue spreading could make further securing steps necessary, as reviewed by Isaacson et al. Becker et al. acknowledge the fact that laparoscopic onco-surgery can be beneficial in many gynecological malignancies, referring to the points of interest that make these operations safer. Puntambekar et al. highlight the aspects critical to successful ultraradical laparoscopic treatment, satisfying standard oncological criteria.

To continuously evaluate not only the benefits but also the complications and thus positively influence the risk rates, Putz et al. present a global registry evaluation. In future, it is imperative that this documentation be of high quality when publishing scientifically validated health science studies. Web-based surgical registries are able to detect complication-inducing risk factors and contribute to outcome improvement. Finally, Cezar et al. state that all surgery-related procedures should be evaluated in prospective studies, and when possible randomized, to clearly demonstrate the benefits before implementing them in daily routine practice. Moreover, secondary detection of never-seen complications can be avoided. Before a clinical and surgical first-in-human study is initiated, preclinical evaluation of the product investigation is mandatory to allow an acceptable safety before the proposed in-human application.

The authors and the guest editor wish to thank Prof. Peter O’Donovan for his high-level comments and guidance during the structuring of this edition.