Abstract
<title>Abstract</title> <p> <bold>Background</bold> Laparoscopic surgery in super-obese patients (BMI ≥ 50 kg/m²) poses distinctive anesthetic and technical challenges. Reports describing emergency adnexal surgery in this group are rare. <bold>Case presentation</bold> We present a 27-year-old woman (BMI 55.5 kg/m²) who was admitted with acute pelvic pain due to a complicated twisted paraovarian cyst. Following multidisciplinary planning, she underwent emergency laparoscopic paraovarian cystectomy using modified positioning, special long instruments, and close aesthetic–surgical coordination. Both intraoperative and postoperative courses were uneventful. <bold>Conclusion</bold> It is concluded that with careful anesthetic planning and technical adaptation, emergency laparoscopic gynecologic surgery can be safely performed in super-obese patients through teamwork and appropriate perioperative management. </p>