Describe technique/indication for a vNOTES case. An ovarian torsion due to a large hemorrhagic cyst, with bilateral salpingectomy for sterilization in a patient with multiple prior abdominal surgeries. NOTES (Natural Orifice Transluminal Endoscopic Surgery) uses the body's natural orifices (mouth, vagina, and anus) to access the cavities of the human body to perform surgical interventions. This decreases the magnitude of surgical trauma and likely reduces postoperative pain. It is a realistic alternative for open and laparoscopic surgery for multiple gynecologic and general surgery procedures. For gynecologic surgery, the vagina allows ready access to the peritoneal cavity via the posterior cul de sac. Although not yet widely done in the United States, it is becoming more prevalent in Europe and China, with studies underway comparing it with traditional laparoscopy. Transvaginal NOTES (vNOTES) combines single site surgery techniques with vaginal surgery, and adnexal surgery lends itself especially well to this approach. This video demonstrates vNOTES technique for performing common adnexal procedures. A 40 year old G4P4 patient presented with acute LLQ pain, a large hemorrhagic ovarian cyst with torsion, and she also desired sterilization. She had a history one year earlier of bowel resection/reanastomosis surgery with a vertical midline upper abdominal incision and also a remote laparoscopic cholecystectomy. She underwent cyst drainage, ovarian detorsion and bilateral salpingectomy via transvaginal laparoscopy. She had an uncomplicated postoperative course and required no narcotics. vNOTES is expanding the options for minimally invasive gynecologic surgery by allowing common gynecologic procedures to be done without incision through the transvaginal route.