Objective: A review is made to determine whether the use of the endoscope in endodontic surgery offers advantages in clinical practice, and whether it improves the clinical and radiographic outcomes of the procedure. Material and methods: The main search terms used were: endodontic surgery, apicoectomy, apical surgery, endoscope, and magnification devices . The authors searched the Medline database for articles published up to 1 September 2010. The review included experimental studies comparing endoscopic microstructural findings with the findings of the naked eye or other magnification devices, as well as prospective clinical trials comparing endodontic surgery with or without the use of an endoscope, or comparing the endoscope with some other magnification device. Results: Two experimental studies on the capability of the endoscope to identify microstructures and three prospective clinical trials were included in the review. The experimental studies showed the endoscope to be highly precise in application to intraoperative diagnoses in periapical surgery. There were no significant differences in the prognosis of periapical surgery when performed with or without endoscopy. Likewise, there were no significant differences among the use of endoscopy, magnifying lenses or the microscope. Conclusion: Experimental studies have demonstrated the usefulness of the endoscope in identifying microstructures during periapical surgery. However, further randomized and controlled clinical trials are needed to determine whether these advantages in clinical practice imply improved outcomes for periapical surgery.