Microsuturing and microinstruments for operative laparoscopy has allowed the convergence of laparoscopy and traditional microsurgery, resulting in the evolution of the “new microsurgery.” This more dynamic approach overcomes the limitations of open microsurgery by providing continuous magnification and the benefits of a closed environment and makes laparoscopy a complete surgical tool. The test model for microsurgery is tubal anastomosis, which is very dependent on operative technique to attain well-established pregnancy rates. Our cumulative pregnancy results for laparoscopic microsurgical tubal anastomosis of 76% at 12 months, 70% at 9 months, 67% at 6 months and 44% at 3 months, compares favorably to the best results achieved by traditional open microsurgery. With this validation, the technique is now employed as a complete solution for all tubal surgery. The ability to affect microsurgical repair of ureter, bladder, bowel and vessels has expanded the surgical repertoire, allowing radical excision of deep endometriosis, severe enterolysis and adhesiolysis. Laparoscopic microsurgery is that tool which improves on the deficiencies and limitations inherent in open microsurgery for tubal disease and enlarges the surgical repertoire for microsurgery beyond tubal indications. These newer techniques e.g., ureter microdissection and anastomosis, vascular repair and radical microsurgery for endometriosis, bowel adhesiolysis and repair, herald its evolution to become the universal surgical tool for reproductive and major gynecological surgery. Microsuturing techniques perfected for tubal anastomosis become the stimulus for advancement of endoscopic cardiac, vascular, pediatric and fetal microsurgery. This article describes the author’s progress in developing this discipline and reviews contemporary literature on other approaches to solutions for tubal surgery including “laparoscopically-assisted” techniques. The new microsurgery is delivered laparoscopically and is applicable for all tubal repair as well as for the radical excision of deep endometriosis in a manner not previously attainable by open microsurgery. Laparoscopic microsuturing can be successfully taught and will begin to see applications not only in gynecological reproductive surgery but also in pediatric, urologic, cardiovascular and fetal surgery. Laparoscopic microsurgery—the future beyond gynecology, “Today’s empowerment and progress by endoscopic microsuturing will pave the way for tomorrow’s progress”.