Background <p>Transumbilical laparoendoscopic single-site surgery (TU-LESS) has been widely used in multiple gynecological fields, but the report on its use during during pregnancy is limited. This study aimed to assess the safety and feasibility of TU-LESS for gynecological diseases at different pregnancy stages, and evaluate the application of Zheng’s anchor suturing for pregnant women.</p> Methods <p>An observational study was conducted retrospectively on pregnant women who underwent TU-LESS during pregnancy between September 4th, 2019 and May 23th, 2024, at the West China Second Hospital, Sichuan University. The umbilical incision was sutured using Zheng’s anchor suturing technique. Patients’ characteristics and perioperative outcomes were collected from the medical record system. The postoperative outcomes, obstetric outcomes and cosmetic satisfaction for incision were collocted by telephone follow-up. Subsequently, the clinical characteristics, perioperative data, and obstetric outcomes were recorded and analyzed. Perioperative data of patients in the first and second trimesters were analyzed.</p> Results <p>In total, 75 patients were included, 23 of whom were in their first trimester and 52 were in their second trimester. There were 56 cases of adnexal mass, 15 cases of adnexal torsion, 2 cases of rupture of adnexal mass, and 2 cases of intrauterine pregnancy combined with ectopic pregnancy. All surgeries were performed by TU-LESS and no perioperative complications occurred on patients during hospitalization. More emergent surgeries (9/14) were performed in the first trimester, and more elective surgeries (5/47) were performed in the second trimester (<i>P</i> = 0.008). No significant differences were found in the perioperative data (operative time, postoperative Activities of Daily Living, and postoperative pain intensity, postoperative hospital stay, total hospital stay) between patients in the first and second trimesters. Most incisions healed well except in one patient who had secondary suturing for incisional dehiscence. A total of 59 patients completed the follow-up for obstetric outcomes, 3 of whom experienced fetal loss and the remaining 56 patients had live births. Among the 56 patients who had live births, 27 of them had vaginal delivery and 29 had Cesarean section. The interval from TU-LESS to childbirth was 23.3 ± 4.4&#xa0;weeks. No incisonal dehiscence or hernia occurred in patients who underwent vaginal delivery.</p> Conclusion <p>TU-LESS is a safe and effective method for treating gynecological diseases during pregnancy, both in the first and second trimesters, with few perioperative complications. The umbilical incision sutured with Zheng’s anchor suturing technique can withstand the tension of a growing abdomen and the pressure of uterine contractions during labor.</p>