The development of dilatation and evacuation (D&E) as a method of second trimester surgical abortion occurred soon after abortion law reform took place in the 1960s and 1970s in Europe and the United States. Today, D&E is the predominant method of second trimester abortion in many parts of the world. Debate still exists as to whether surgical or medical methods are optimal for second trimester pregnancy termination. A continuing challenge to provision of D&E is the availability of a large enough pool of skilled providers. This article reviews the current surgical methods used in second trimester abortion, as well as their safety, advantages and disadvantages, acceptability and associated complications. Methods used to ensure safe and efficient surgical termination of second trimester pregnancies such as cervical preparation and ultrasound guidance are also reviewed.