Abdominal Exploration

Verres or Hasson entry, 30° camera, & triangulate ports on target anatomy.
Explore likely sites of organ invasion, for mets, & corresponding lymph node basins.
Biopsy suspicious lesions/nodes. Minimal electrocautery.
For gastric and gastroesophageal junction cancers evaluate:
- GE junction, anterior stomach, liver, & lesser sac.
- Subphrenic, subhepatic, & lesser curve lymph nodes.
- Do pelvic washings.
For liver cancer evaluate:
- Liver surface & any extrahepatic lesions (would make it unresectable disease).
- Rarely needed with modern imaging.
For body & tail pancreatic cancer evaluate:
- Lesser sac contents/pancreas & peripancreatic/gastroduodenal nodal basins by dividing gastrohepatic ligament.
- Do peritoneal washings.
For proximal bile duct & gallbladder cancer evaluate:
- Liver surface, evidence of mets, & perihepatic lymph node basins.
- Liver invasion depth via laparoscopic ultrasound.
- Do peritoneal washings.

Educational aid only. Verify every dose, indication, and guideline against current institutional protocol. This is not a substitute for clinical judgment.