AIM: To evaluate the clinical efficacy and safety of pneumoperitoneum-free single-hole endoscopy combined with ropivacaine local infiltration anesthesia in pregnancy with ovarian tumor. METHODS: Twenty-eight pregnant women with ovarian tumor were randomly divided into two groups: observation group (n=16) and control group (n=12). The first time out of bed, ventilation time, postoperative hospital stay, non-invasive blood pressure, heart rate (HR), respiratory frequency (RR) and blood oxygen saturation (SpO2) were compared between the two groups. Pain score, Ramsay sedation score, SAS anxiety score, postoperative complications, patient satisfaction and recovery quality scale QoR15 were evaluated at 6, 24 and 48 hours after operation. RESULTS: There was no significant difference in postoperative hospital stay, Ramsay score, RR, SpO2 and the incidence of complications between the two groups(P>0.05), but the time of getting out of bed and ventilation time were shortened, the scores of non-invasive blood pressure, HR, pain and anxiety in the observation group were lower than those in the control group, and the scores of patient satisfaction and QoR15 in the observation group were better than those in the control group (P<0.05). CONCLUSION: The application of pneumoperitoneum-free single-hole endoscope combined with ropivacaine local infiltration anesthesia in pregnancy with ovarian tumor can reach satisfactory clinical results, including reducing postoperative pain and anxiety, which is worth popularizing.