Design: Narrated video footage of the operative management of a TOA.

Setting: A tertiary, academic hospital with a high volume minimally invasive gynecology specialist.

Patients or Participants: A 42-year-old with a history of a TOA presented with nausea, vomiting, and abdominal pain. A CT abdomen and pelvis showed persistence of the TOA and she was admitted for conservative medial management with IV antibiotics.

Interventions: Despite conservative management, the patient’s clinical status deteriorated, and she underwent surgical evaluation and treatment.

Measurements and Main Results: The patient had a diagnostic laparoscopy, left salpingo—oophorectomy, left ureterolysis, and cystoscopy. Surgical evaluation revealed significant inflammatory and adhesive disease due to extensive pelvic infection. Pelvic anatomy was restored by understanding anatomical relationships. Using essential laparoscopic techniques such as traction-countertraction and blunt dissection, the infection source was identified and treated in a systematic approach. The pathology was consistent with a left TOA and endometrioma. The patient was transitioned to an extended course of oral antibiotics and had improvement in her clinical symptoms postoperatively.

Conclusion: Tubo-ovarian abscess can be managed conservatively with intravenous antibiotics or image-guided IR drainage. When conservative management methods fail or the patient becomes clinically unstable, expeditious surgical management is the standard of care. Minimally invasive methods can be safely accomplished and utilized in difficult cases to manage extensive pelvic infections by following foundational surgical principles.