Trans-vaginal laparoscopy (TVL) was performed in a patient at high risk for ovarian cancer (OC). During a routine check-up vaginal sonography and color Doppler studies revealed neoangiogenesis with low resistance in both sides. The left ovary was slightly enlarged, and the increased blood vessels were seen in the center and in the periphery of the left ovary. The patient was placed in the lithotomy position after sedation, and a veres needle was inserted in the posterior vaginal vault. A trocar followed, and warm normal saline was injected in the pelvis. The needle was removed, and a telescope was introduced, connected to a light source and a monitor. Excellent visualization was achieved, and the average time of TVL was 30 min. Dilated veins in both adnexa and pelvic tissues due to severe obesity were visualized. TVL helped in establishing the diagnosis, saving this patient from an unnecessary laparoscopy or laparotomy.