OBJECTIVE Since its introduction 5 years ago, almost all open urological procedures have been performed laparoscopically. We provide an in-depth critical review. METHODS More than 200 articles on laparoscopic urology were reviewed. All laparoscopic procedures were divided into clinically established, clinically anecdotal and laboratory procedures. Comparisons between the laparoscopic and open method were carefully analyzed. RESULTS There were 5 clinically established procedures identified. In general, the laparoscopic procedures were as efficacious but less morbid and required less convalescence than their open counterparts; however, none was less costly. CONCLUSIONS Despite the time-consuming and costly nature of laparoscopy, the decreased morbidity and brief convalescence that are the hallmarks of minimally invasive surgery are evident and well documented. Further dissemination of laparoscopic skills through postgraduate urology training programs and during urology residency is of the utmost importance.