Figure1 Computed tomography shows a giant cystic lesion in the abdomen Figure2 Laparoscopic view of the giant ovarian right cyst after decompression Figure3 An intraumbilical incision is used to exteriorise and decompress the cyst Figure4 One 10-mm trocar (camera port) is placed through the umbilicus. Figure5 The ‘spaghetti manoeuvre’ is used to roll the cyst around a grasper Discussion Other authors have claimed that a minimally invasive approach is impractical for giant ovarian cysts because of the restricted operating field, the possibility of malignancy and the tendency of cysts to rupture, but we believe that pure laparoscopic evaluation and excision is a safe and feasible treatment if performed by experienced surgeons. The laparoscopic approach may reduce postoperative adhesions that can be associated with significant benefits, including improved fertility, reduction in pelvic pain and improved quality of life.