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.
Systematically explore all intraabdominal organs and surfaces: Bowel, liver, gallbladder, diaphragms, mesentery, omentum, and the entire peritoneum should be visualized and palpated, as indicated.
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.
The omentum should be resected from the transverse colon.
The retroperitoneum should be explored to evaluate pelvic nodes. Suspicious nodes should be removed and sent for frozen section examination.
The paraaortic nodes should be exposed and enlarged nodes removed. Nodes superior to the inferior mesenteric artery should also be resected.
In the absence of suspicious nodes, pelvic and paraaortic nodes should still be sampled to exclude the possibility of microscopic stage III disease.
A total abdominal hysterectomy and bilateral salpingo-oophorectomy is performed. (Fertility-conserving surgery may be an option for some patients.)
Graphic 75194 Version 7.0
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