Laparoscopic management of a massive ovarian cyst in pregnancy Dr. Adam Rosen1, Dr. Neha Sarna1, Dr. Nir Melamed, Dr. Jamie Kroft. Sunnybrook Health Sciences Centre, University of Toronto Laparoscopy in pregnancy is challenging, requiring careful perioperative planning and surgical skill. Here, we demonstrate the management of a complex 26 cm left ovarian cyst at 17 weeks gestation in a woman with body mass index of 44 and history of previous pulmonary embolism. Patient counselling, multidisciplinary care, surgical considerations including equipment and patient positioning, and intraoperative troubleshooting and decision making are reviewed. The patient was taken to surgery for a planned ovarian cystectomy, but due to her challenging anatomy and complexity of the cyst, a salpingo-oophorectomy was performed. Final pathology revealed a borderline mucinous tumor confined to the ovary. There were no maternal or fetal complications, she has done well during her post-operative course and is currently 37 weeks gestational age.