Neonatal minimally invasive surgery requires small, light-weight instruments and excellent image quality to be performed safely and efficiently. We performed laboratory studies comparing the image quality of a new 3-mm 14-cm telescope with a 5-mm 25-cm telescope with identical viewing angles and found they were very similar. We employed the new 3-mm telescope exclusively in endosurgical procedures on 5 infants weighing less than 4 kg and found the image quality and light intensity to be more than adequate. In addition, we found the shorter length and lighter weight easier to maneuver in the limited working space of the neonatal abdomen or hemithorax. Our experience with the new 3-mm telescope is superb for the demands of complex neonatal endosurgical procedures.