Objective  To analyse all laparoscopic treatment of cystic adnexal tumours in the period 1998–2000. Design  Retrospective evaluation of surgical procedures (Canadian Task Force classification III). Setting  University department of obstetrics and gynaecology. Patients  427 patients with cystic adnexal masses. Interventions  141 patients underwent an adnectomy/ovariectomy and 286 an ovariectomy, ovarian cyst enucleation or biopsy by operative laparoscopy. Results  Laparoscopic treatment was possible in 97% of patients with adnexal masses. In 10 patients (2.3%) a conversion to laparotomy was necessary. Conclusions  After careful evaluation, most cases of adnexal mass can be managed laparoscopically. The risk of missing a malignancy is very low. Proper attention to techniques and training reduces complications and the risk of spillage.