PIP: This discussion examines the state of the art with respect to tubal microsurgery. Clearly enumerated by Swolin, Winston, and Gomel, the principles of microsurgery are firmly established and include adequate exposure, excellent hemostasis, the use of fine cautery, meticulous tissue handling and avoidance of peritoneal abrasion, constant irrigation, use of fine nonreactive sutures and specially designed instruments, accurate tissue approximation, and the use of magnification. If these techniques are to be employed, the surgeon needs to undergo extensive training. Presently available data with respect to salpingolysis and ovariolysis, salpingostomy, and anastomotic procedures are reviewed in an effort to determine if the results using microsurgery are demostrably better. There is little question that the employment of microsurgical principles allows a finer dissection of adhesions, with less trauma, and hence less likelihood of their reformation. Such delicate dissection should allow for greater restoration of the relationship between the ostium and the ovary. Current data, although encouraging, fails to support the absolute need for the operating microscope to perform the procedures. Loupes may provide adequate magnification and some individuals with above average visual acuity may be able to achieve excellent results using the naked eye. Linear, isthmic, and distal salpingostomy are described. Linear salpingostomy is no longer performed except in the conservative management of ectopic pregnancy. Palmer achieved 2 uterine and 2 ectopic pregnancies in 44 women upon whom he had performed isthimic salpingostomy. Because in these cases there is no possibility of any recovery by an ovum pickup mechanism, it is unlikely that the additition of microsurgical techniques would improve these figures. Terminal salpingostomy has been performed by both conventional and microsurgical means. Comparison of published series is difficult, yet it appears that microsurgical approaches may offer some advantages over conventional methods but at a cost of a considerably increased ectopic pregnancy rate. Microsurgical anastomosis is superior to traditional reimplantation methods. It cannot be performed successfully without the magnification provided by the operating microscope. For intramural tubal anastomosis the higher powers available with the microscope are essential. Opinion is divided as to whether or not such high powers are required for salpingolysis, salpingostomy, or tubotubal anastomosis. 2 problems need to be overcome: prevention of adhesion formation and maintenance of tubal patency. No adjunctive measures can or will substitute for delicacy in handling, accurate hemostasis, prevention of tissue drying, avoidance of peritoneal trauma, and accuracy of suture placement. The status of laser surgery while improving must await further experience, properly performed studies, as well as larger published series.