Background: Accurate preoperative initial evaluation of adnexal masses to distinguish between benign and malignancy is essential to plan the extent and surgical mode. The purpose of our study was to assess the effectiveness and precision of the international ovarian tumor analysis (IOTA) scoring model in low-resource settings of peripheral islands of India. Material and Methods: A retrospective study of all cases operated for adnexal mass in our department between 2017 and 2021 was carried out in this medical college. Cases of adnexal mass were subjected to IOTA scoring, tumor markers, and clinical profile analysis and were classified as presumptively benign, malignant, or inconclusive to decide the mode of surgery. The diagnostic performance of the IOTA system was evaluated and different variables were analyzed. Result: Among total of 53 patients, 32 (60.3%) could undergo laparoscopic management. Only one case of the borderline endometrioid tumor was missed as benign by the scoring system (3.1%). The sensitivity of the IOTA regression system was 93%, the specificity 83.78%, and the positive and negative predictive values were 71% and 96% respectively. The negative likelihood ratio was 0.07 and accuracy was around 86%. None of the cases needed intraoperative conversion. Conclusion: International ovarian tumor analysis (IOTA) scoring system is a simple, clinically feasible diagnostic tool that accurately distinguishes benign from malignant adnexal pathologies and can guide in deciding on a laparoscopic approach. Clinical significance: Benefits of laparoscopy can be provided even in low-resource setup by use of the IOTA ultrasonic scoring model.