The introduction of endoscopy into surgical practice is one of the biggest success stories in the history of medicine. Endoscopy has its roots in the nineteenth century and was initially developed by urologists and internists. During the 1960s and 1970s gynecologists took the lead in the development of endoscopic surgery while most of the surgical community continued to ignore the possibilities of the new technique. This was due in part to the introduction of ever more sophisticated drugs, the impressive results of intensive care medicine, and advances in anesthesia, which led to the development of more radical and extensive operations, or "major surgery." The idea that large problems require large incisions so deeply dominated surgical thinking that there was little room to appreciate the advances of "key-hole" surgery. Working against this current, some general surgeons took up the challenge. In 1976 the Surgical Study Group on Endoscopy and Ultrasound (CAES) was formed in Hamburg. Five years later, on the other side of the Atlantic, the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) was called into being. In 1987 the first issue of the journal Surgical Endoscopy was published, and the following year the First World Congress on Surgical Endoscopy took place in Berlin. The sweeping success of the "laparoscopic revolution" (1989-1990) marked the end of traditional open surgery and encouraged surgeons to consider new perspectives. By the 1990s the breakthrough had been accomplished: endoscopy was incorporated into surgical thinking.