The use of operative laparoscopy for paraovarian cysts in pregnancy is relatively new. A 26-year-old primigravida at 20 weeks of gestation was discovered to have a 20 x 15-cm adnexal cyst during ultrasound. Laparoscopic excision of the 20 x 15-cm paraovarian cyst after aspiration of 2.5 L of fluids was performed without complications. The operative time was 60 minutes. The patient was released from the hospital less than 24 hours after surgery in good general condition. Follow-up in the outpatient clinic was satisfactory. The final histopathology confirmed the 20 x 15-cm paraovarian cyst. The patient delivered vaginally and spontaneously at term. Operative laparoscopy may be safe for removing large paraovarian cysts during pregnancy.