This video demonstrates a minimally invasive stepwise approach to surgical management of the tubo-ovarian abscess. Patient characteristics with high likelihood of requiring surgical intervention for TOA and considerations for pre-operative optimization are reviewed. Three novel surgical techniques are illustrated to help avoid intra-operative complications, particularly involving the bowel. ‘Gravity for traction’ with sharp dissection, gentle interrogation of tissue planes and ‘tissue plane surfing’ are demonstrated to achieve normalization of anatomy and surgical goals. The role of salpingectomy in fertility and non-fertility cases is also explored.