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The elimination of the need for a pneumoperitoneum, by use of a mechanical abdominal wall elevation device, the use of epidural anaesthesia, an open laparoscopic entry technique and the avoidance of multiple laparoscopic trocar sites allowed for the safe, effective, and rapid treatment of symptomatic adnexal pathology in two pregnant patients during the second trimester of pregnancy. The first case required the removal of a 10×13‐cm dermoid cyst with torsion of its pedicle, and appendectomy. The second patient underwent the removal of symptomatic, large, bilateral endometriomas. Our experience suggests that in selected cases, this minimally invasive approach can successfully replace laparotomy and its associated morbidity, and avoid the potentially deleterious effects of arbon dioxide pneumoperitoneum and general anaesthesia upon the fetus and pregnant mother.

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