Modern endodontic microsurgery has evolved beyond simply removing pathology to preserving biology through precision. Advances in magnification, microsurgical instruments, ultrasonic root-end preparation, and biocompatible materials now enable highly conservative procedures with predictable healing and long-term success. This lecture highlights evidence-based strategies for minimally invasive microsurgery, emphasizing biologically driven treatment planning, precise surgical execution, and optimized tissue healing. Participants will gain practical insights into performing less invasive, more predictable microsurgical procedures while maximizing tooth preservation and patient outcomes.