AbstractObjective: To determine the economic feasibility (from the patient's viewpoint) of laparoscopic adnexectomy (LA) in a developing country. Method: Forty‐four LA cases of benign ovarian cysts or tubal pregnancy were compared with 44 conventional open adnexectomy (OA) cases treated during the same period and matched by diagnosis, procedure and degree of difficulty. Result: The postoperative hospital stay was 1.3 ± 0.6 days (mean ± S.D.) and 5.3 ± 1.1 days (P<0.001) for the LA and OA groups, respectively. LA cases had a shorter recovery period (5.8 ± 2.2 days vs. 27.2 ± 6.6 days, P<0.001), but higher hospital charges (US$463.3 ± 84.9 vs. US$229.8 ± 92.2, P<0.001), caused mainly (89.2%) by disposable laparoscopic instruments. Incremental cost‐benefit analysis revealed a possible saving with LA for higher income patients (US$9.2 per day). Conclusions: LA in Thailand may have economic benefit only to the higher income patients. Benefits to other patients in developing countries will depend on future cost reductions of disposable instruments and/or more effective use of reusable instruments.