it left only one hand free, limited their field of vision, and required them to hunch over and move around in awkward positions. With these physical limitations in place, surgeons found it difficult to believe that operative laparoscopic techniques could replace classical surgery and, initially, many in the medical community considered the entire notion to be an untenable, unrealistic, and dangerous idea. The idea of using the endoscope as an operative device also went against at least 200 years of medical tradition, which had established the endoscope, since its approximately 1806 modern debut of endoscopy by Philip Bozzini, as a predominantly diagnostic tool; operative applications in gynecology were confined to simple interventions, such as lysis of adhesions (removal of scar tissue), biopsies, draining of cysts, cautery of neoplasms, and tubal ligations. When Nezhat began using his new video-laparoscopic technique of operating off the monitor in an upright position, he was able to achieve more advanced operative procedures for the first time. Performing these advanced surgeries laparoscopically was the second unorthodox conceptual change that Nezhat introduced. Other innovations by Nezhat that were considered controversial included the introduction of new surgical procedures and new surgical instrumentation designed specifically for use in laparoscopy. Because these new surgical concepts went against established norms of classical surgery and were believed to be dangerous, Nezhat fell under intense scrutiny and criticism from those within mainstream medical establishments, and later from the national newspapers (see "Controversies" section below). For approximately the next 25 years, Nezhat became one of the most visible and controversial figures in the minimally invasive movement because of his vocal advocacy of these new techniques and for continuing to push the envelope by performing more advanced procedures laparoscopically. Even as late as the 2000s, there were many opponents to these techniques who continued to call into question the safety and necessity of video-laparoscopy, especially when used for more advanced laparoscopic techniques. However, by approximately the mid-1990s it can be established that most of the initial misgivings about video-laparoscopy had subsided because by then the nation's most prominent academic medical schools in the U.S., such as Stanford University School of Medicine, had adopted this change and began teaching it as part of the standard medical school curriculum. By the early 2000s, many medical societies, such as American Association of Gynecologic Laparoscopists, Society of Laparoendoscopic Surgeons, and the Society of American Gastrointestinal and Endoscopic Surgeons, also