This work is derived from the International Symposium on Advanced Laparo-Endoscopic Surgery, reknowned for being a comprehensive program that brings together international leaders in the field to discuss the current state of practice, the emerging possibilities and the future directions for research. The program focuses on the experiences in large series which have set the standard of practice and won acceptance for laparo-endoscopic surgery in recent years; the panelists and lecturers span the field from concept to realization. The program also addresses the evaluation process by which innovations should be judged in the interest of safety, clinical efficacy and cost effectiveness to improve the delivery of surgical care in the world. The symposium clebrates the firm establishment of laparo-endoscopic surgery and the promise of the future. Together, members of the panel outline future innovations that will change the practice of laparoscopic surgery, showcasing the future of robotics, virtual reality, telesurgery, needlescopic surgery, minimally-invasive breast surgery, cryotherapy and live donor nephrectomy. Highlights include contributions by John Hunter (Endo-Gastric Surgery), Dana Anderson (Repair Common Bile Duct Injury), Jack Jackimowicz (European Laparoscopic Hernia Multi-Institutional Study), Alfred Cuschieri and John Flowers (Role of Clinical Trial for New Procedures).