Unless contraindicated by infection in the pelvis, a general abdominal exploration is carried out. The surgeon moistens his or her hands in saline and systematically explores the abdomen and finally the pelvis. The surgeon's operative note should contain a description of the findings, especially the presence or absence of gallstones. If a large uterus with extensive involvement by fibromyomata is encountered, it may be advantageous to deliver the uterus through the abdominal opening before the introduction of the self-retaining retractor. Large ovarian cysts, if benign and not grossly adherent, may be reduced in size by aspirating their contents through a trocar, great caution being used to avoid contamination from their contents. If the surgeon suspects ovarian malignancy, the organ is removed intact and a frozen section is performed. Additionally, the surgeon should perform a saline peritoneal lavage for cytology and biopsy of the pelvic, lateral abdominal and diaphragmatic peritoneal surface. Comprehensive staging of ovarian cancer also includes a pelvic periaortic lymph node dissection, infracolic node removal, and sampling of the iliac and preaortic lymph nodes. A tenaculum is applied to the fundus of the uterus to maintain traction while the intestines are walled off completely with several moist gauze pads. To accomplish this, the intestines are retracted upward by the left hand as the gauze pads are directed inward and upward by long, smooth dressing forceps, the packing being continued until the pelvis is free of small intestine. The pouch of Douglas is emptied of intestines, other than the rectosigmoid, and is likewise protected by a gauze pack. To maintain these packs in position, a moderate-sized smooth retractor is sometimes placed in the midline at the umbilical end of the wound.