Endodontic microsurgery is a part of dentistry that deals with the diagnosis and treatment of endodontic lesions that does not react to the traditional endodontic treatments.. Although the success rate for primary and secondary root canal therapy is 68%-85% and 70%- 86% respectively, In cases with damaged root performing RCT is impracticle. Therefore, an endodontist opts for an endodontic microsurgery as RCT. Endodontic surgery has evolved into Endodontic Microsurgery. Microsurgical technique is a minimally invasive procedure resulting in faster healing and a better patient response. Endodontic microsurgery has a higher success rate than the traditional root canal therapy. This procedure includes incision and reflection of the buccal mucosa followed by locating the apices of the root of the infected tooth by removing the buccal bone. Followed by removal of the infected periradicular tissue and root end resection. Finally, the root end cavity is obturated with Mineral Trioxide Aggregate (MTA) and the surgical site is sutured. This article will review the classes of microsurgical cases, indications, contraindications, microsurguical instruments used and the step by step procedure of Endodontic Microsurgery.