(1) Background: adnexal masses during pregnancy detection are increased due to the use of first trimester screening and to advanced maternal age. Although the low risk of malignancy, other risks are associated: torsion, rupture or labour obstruction. Correct diagnosis and management are fundamental to guarantee both maternal and fetal safety. Adnexal masses may be troublesome to classify during pregnancy due to the increase in the uterus volume and to pregnancy-related hormonal changes. Management should be based on ultrasound examination to provide the best treatment. (2) Methods: the aim was to describe the ultrasound features of ovarian masses detected during pregnancy. We evaluated patient’s management, perinatal outcomes and follow-up. (3) Results: our study demonstrated that the management should be guided by an accurate ultrasound examination performed by an expert operator according to standardized techniques. Secondly, our results confirm the data present in the literature: the masses are most frequently benign, ultrasound follow-up is the best management strategy and obstetric outcome is not considerably affected. (4) Conclusions: the management of patients with ovarian masses detected during pregnancy should be based on ultrasound examination and a centralization in referral centers for ovarian masses should be considered.

Surgical approaches for ovarian cancer have advanced significantly in recent years. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging technique in gyneco-logical oncology, with limited reports of its use in ovarian cancer management. This study aimed to evaluate the feasibility and safety of vNOTES for the surgical staging of early-stage adnexal malignancies. Methods: We retrospectively reviewed all cases of borderline ovarian tumors (BOTs) and early-stage ovarian cancer surgically staged using vNOTES at our institution between October 2021 and August 2024. Results: Eleven patients were included, 7 with ear-ly-stage ovarian or tubal cancer and 4 with BOTs. The median age was 47 (27 – 81) years, and the median body mass index was 28.1 (22.4 – 39.2) Kg/m². Complete vNOTES staging was achieved in all cases, including peritoneal washing, unilateral/bilateral salpingo-oophorectomy, ab-dominal cavity inspection, peritoneal biopsies, infracolic omentectomy, and total hysterectomy when required. The median operating time was 70 (35 – 138) minutes, with a median blood loss of 50 (10 – 100) mL. No intraoperative complications occurred except for one case of minor ovar-ian spillage. No conversions to laparoscopy or laparotomy were needed. Postoperative compli-cations included one surgical site infection (9.1%) and two cases of postoperative cystitis (18.2%). No severe complications graded ≥3 on the Clavien-Dindo classification were observed. Conclu-sion: vNOTES appears to be a feasible and safe approach for the surgical staging of selected pa-tients with early stage adnexal malignancies. Further studies are needed to validate its long-term safety and oncological outcomes.