Minimal access, whenever feasible, in the performance of most general surgical procedures is now well established. However, many areas still need clari? cation. They range from indications and contraindications to the optimal route of access, as well as to choices to be made among the various procedures possible for any single surgical problem. This M- ual is unique in that unlike most manuals it is not so much a “how to” but more a “when to,” the “how to” having been covered to a signi? cant extent in the two previous SAGES manuals. This work takes a series of common clinical scenarios and offers various, detailed, often contrasting approaches, commonly but not exclusively minimal access, discussing indications, limitations, and potential complications. In this age of evidence-based surgical practice, the reader will ? nd it refreshing to have abundant data and references to support or reject a particular approach or technique. With a cadre of surgeon authors skilled in open as well as minimal access surgery, including ? exible endoscopy, the student and practitioner of surgery is exposed to not only varying approaches to many common surgical conditions but also comes to appreciate how ? exibility and integration of various approaches can improve the outcome for the patient. The forty-six chapters can each constitute a stand-alone discussion.