The management of an adnexal mass combines the need for appropriate workup and sound judgement to ensure the optimal outcome. Whereas the laparoscope is an essential tool in the surgical armamentarium, it should only be employed in an appropriate fashion, relegating some patients to be best managed by laparotomy. The adnexa includes the ovary, fallopian tube, broad ligament, blood vessels, and fascia contained within. Acknowledging there are many causes for a pelvic mass, this chapter only considers gynecologic conditions. Once an adnexal mass is identified, fundamental questions that must be addressed include the following: What is the origin of the mass? Are there additional laboratory or radiologic studies that would be useful? Does it require surgical removal, and if so, what type of surgery would be most appropriate?