OBJECTIVE: Our purpose was to compare four microendoscopes to evaluate their clinical and cost effectiveness. STUDY DESIGN: The experience of 27 patients scheduled for diagnostic or minor operative procedures is reported. All patients had microendoscopic laparoscopy performed using the Medical Dynamics optical catheter (Englewood, Col.), the Origin Pixie microendoscope (Menlo Park, Calif.), the Imagyn Microlap (Laguna Niquel, Calif.), or the Karl Storz microendoscope (Culver City, Calif.). A 5 mm conventional laparoscope was used when visualization was inadequate. RESULTS: Thirteen patients had tubal sterilization. Fourteen patients had diagnostic laparoscopy. For 22 patients the microendoscopes were adequate. The remaining 5 patients required the use of a 5 mm laparoscope to complete the procedure. Among the microendoscopes, the Imagyn Microlap was considered to have the best combination of field of vision, clinical adaptability, ease of operation, mode of sterilization, and operating cost. The 5 mm endoscope provided the best visualization at the lowest overall cost. CONCLUSION: Microendoscopes are adequate for diagnostic and minor operative procedures. The 5 mm endoscope is the most clinically cost effective. (Am J Obstet Gynecol 1996;174:1757-62.)