Laparoscopic Assessment of Resectability in Ovarian Cancer: A 10-Step Standardized Approach.

OBJECTIVE: Exploratory laparoscopy plays a critical role in assessing resectability in suspected advanced-stage ovarian cancer. Performed early, it guides treatment toward either complete cytoreductive surgery or neoadjuvant chemotherapy. With the implementation of B5 accreditation for expert centers, a French national certification system designating specialized oncologic referral centers, peripheral hospitals are becoming key actors in diagnosis and staging. A well-conducted laparoscopy avoids delays and repeat procedures, thereby improving patient outcomes. This study presents a 10-step laparoscopic protocol that is anatomically ordered, simple, and reproducible, facilitating adoption across both expert and partner centers.

SETTING: Women undergoing initial assessment for suspected advanced-stage ovarian cancer prior to therapeutic decision-making.

PARTICIPANTS: Patients with suspected advanced-stage ovarian cancer referred for diagnostic laparoscopy before determination of the initial treatment strategy.

INTERVENTIONS: This video outlines a standardized exploratory sequence using a strict midline laparoscopic approach (single supraumbilical trocar or two aligned trocars). Each of the 12 regions of the Peritoneal Cancer Index (PCI) is documented photographically. Resectability is assessed using three validated tools: Sugarbaker's PCI, the Fagotti score, and the Makar classification.

CONCLUSION: The 10 steps include: trocar placement; peritoneal cytology with ascites quantification; inspection of the upper abdomen (right and left diaphragmatic domes, liver, spleen); evaluation of the omentum and transverse colon; exploration of the small bowel and mesentery (Trendelenburg); assessment of both iliac fossae and the pelvis; followed by photographic documentation and biopsies. Key elements include early peritoneal cytology and at least four to six wide (10-mm) biopsies obtained using cold scissors. Epiploic biopsy is prioritized for histologic and molecular analysis. Biopsies near hollow organs (bowel, bladder) are avoided to reduce procedural complications. The standardized 10-step sequence is summarized in Annexe 1 to facilitate reproducibility and clinical adoption. This reproducible and structured 10-step approach strengthens the role of partner centers in advanced ovarian cancer care. It improves diagnostic quality, harmonizes staging practices, and supports timely, expert-level treatment planning. Widespread adoption may reduce disparities and promote equitable care. VIDEO ABSTRACT.