G.K. Zherlov, D.V. Zykov, S.V. Kozlov, D.N. Chirkov, Research Institute of Gastroenterology, Siberian State Medical University. Video-endoscopic perforator vein dissection (SEPS) is an alternative to the traditional Linton procedure (subfascial ligation of communicating veins). It is performed using specialized equipment under video monitoring on a monitor. The advantage of this method is that the endoscope is inserted under the skin and fascia of the leg through a small incision in the normal skin in the upper third of the leg. In the traditional Linton procedure, the skin is dissected in the area of ??trophic ulcers and discolored skin, which significantly complicates subsequent healing. Many years of international experience with the Linton procedure and its modifications have confirmed the high efficacy of this method, but also revealed a number of significant drawbacks. Thus, 20–30% of patients undergoing surgery develop purulent-necrotic complications in the immediate postoperative period, significantly prolonging the period of medical and social rehabilitation. In more than half of cases, surgical trauma to the subcutaneous nerves leads to persistent sensory disturbances. It is also important to note that all patients experience a severe cosmetic defect. The negative consequences of the Linton procedure stimulated the search for more gentle options for subfascial transection of perforating veins. D. Albanese (1965) and J. Edwards (1976), using special spatula-shaped instruments with a cutting leading edge that were blindly advanced into the subfascial space, were among the first to perform "closed" subfascial transection of perforating veins with valve insufficiency in chronic venous insufficiency complicated by trophic disorders of the skin of the lower leg. This technique has not gained widespread acceptance primarily due to the high risk of damage to major vessels and nerves. In 1985, German surgeon G. Hauer successfully performed subfascial dissection for the first time using a laparoscopic cholecystectomy instrument set. Immediately before the procedure, the boundaries of the probable locations of incompetent perforating veins with valvular insufficiency, identified by physical or ultrasound methods, are marked on the skin with a brilliant green solution or a special marker. Endoscopic dissection of communicating veins serves not only as a therapeutic but also as a diagnostic procedure, so there is no need for individual marking of perforating veins with valvular insufficiency. After incising the skin, subcutaneous tissue, and the fascia of the leg, it is separated from the underlying muscles using a dissecting swab, scissors, or a scalpel handle. A surgical sheath with an endoscope connected to a lighting system and, via a video camera, to a monitor, is then inserted into the subfascial space. The procedure proceeds under constant video monitoring. The surgical sheath is slowly advanced toward the perforator shunt zone. Large perforators are clipped and small ones are coagulated. The endovideosurgical technique allows for a nearly 50% reduction in postoperative hospital stay and a 7-fold acceleration in return for work compared to the conventional Linton procedure. Regression of trophic skin disorders in the lower leg after SEPS occurs significantly faster than with the conventional Linton procedure, due to the minimization of surgical trauma as a result of the endovideosurgical technique and creates favorable conditions for rapid restoration of skin trophism (Figs. 5 and 6). In contrast, the extensive damage resulting from the dissection of the fasciocutaneous flap during traditional surgery, which typically exceeds the area of ??trophic disorders, slows their regression. For women, who constitute the majority of patients undergoing surgery for varicose veins and post-thrombophlebitic disease, the cosmetic outcome of the procedure is one of the most important criteria for its effectiveness. To evaluate this aspect of endoscopic perforator vein dissection, we surveyed 100 patients who had undergone surgery for varicose veins with recurrent trophic ulcers. One group (45 patients) utilized the SEPS technique, while the other (55 patients) utilized the conventional Linton-Felder procedure. Both groups reported complete satisfaction with the results of the procedure in terms of eliminating trophic skin disorders and other symptoms of chronic venous insufficiency. Meanwhile, the overwhelming majority of women (82%) who underwent the conventional Linton-Felder procedure were dissatisfied with its cosmetic outcome. In the group of patients treated with the SEPS technology (Figs. 7 and 8), only 3 (7%) patients rated the aesthetic outcome of the procedure negatively. In conclusion, the advent of SEPS technology has revolutionized phlebological practice. Endoscopic surgery for chronic venous diseases is in its infancy, and we can expect rapid expansion and further improvement of this new field of surgical phlebology. The development of new instruments and video monitoring systems offers hope for further advancement of this technology for the surgical treatment of chronic venous insufficiency.