- Obtain any free fluid for cytologic evaluation.
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- If no free fluid is present, obtain washings by instilling saline and recovering the fluid. The fluid should irrigate the cul-de-sac, paracolic gutters, and area beneath each diaphragm.
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- Systematically explore all intraabdominal organs and surfaces: Bowel, liver, gallbladder, diaphragms, mesentery, omentum, and the entire peritoneum should be visualized and palpated, as indicated.
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- Suspicious areas or adhesions should be biopsied. If there are no suspicious areas, multiple biopsies should be obtained from the peritoneum of the cul-de-sac, paracolic gutters, bladder, diaphragm, and intestinal mesentery when the disease appears confined to the ovary. These biopsies are not needed if the patient has advanced disease.
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- The omentum should be resected from the transverse colon.
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- The retroperitoneum should be explored to evaluate pelvic nodes. Suspicious nodes should be removed and sent for frozen section examination.
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- The paraaortic nodes should be exposed and enlarged nodes removed. Nodes superior to the inferior mesenteric artery should also be resected.
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- In the absence of suspicious nodes, pelvic and paraaortic nodes should still be sampled to exclude the possibility of microscopic stage III disease.
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- A total abdominal hysterectomy and bilateral salpingo-oophorectomy is performed. (Fertility-conserving surgery may be an option for some patients.)
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