The role of laparoscopy in the diagnosis and treatment of ectopic pregnancy has undergone significant changes in recent years. However, there remain many concerns whether these changes are justified and whether they should be more widely introduced. Current areas of debate include the degree to which trans-vaginal ultrasound, in combination with quantitative assays for sz-hCG, can replace laparoscopy in the diagnosis of ectopic pregnancy; the benefits of laparoscopy, compared to laparotomy, in the treatment of ectopic pregnancy and whether a laparoscopic salpingotomy should be used in preference to salpingectomy. These issues are discussed in this review.