This chapter focuses on the use of laparoscopy in treatment and diagnosis of patients with pelvic pain, adnexal masses, and pelvic inflammatory disease (PID). A discussion of incidental appendectomy in these patients will also be presented. The decision to perform incidental appendectomy is based on the premise that the appendix is a vestigial, functionless organ, with the potential only to contribute to pathological change. PID can have devastating consequences to adolescent females. With the advent of in vitro fertilization, surgeons should attempt to perform the most conservative surgery that is safely possible, in order to maintain the option of future childbearing. Diagnosis of endometriosis should not be delayed in adolescents. A delay may not only postpone symptomatic relief but also worsen the patient's future fertility and allow the disease to progress. Laparoscopy, as it applies to the pediatric and adolescent population, is a relative newcomer to the field.