Surgical assessment and histologic evaluation are the only means by which a neoplasm can be classified as benign or malignant, primary or metastatic. The initial surgical approach to patients with epithelial ovarian cancer is a critical first step. The principles of management of ovarian cancer include assessment of preoperative risk of cancer thorough surgical staging to determine extent of disease and need for further therapy in early disease, and removal of all tumors in patients with advanced disease. Surgical staging is critical in defining patients in whom surgery alone may be curative and in those who require adjuvant therapy, and to determine the modality, intensity, and duration of such treatment. Accurate surgical staging permits assignment of prognosis, allows comparison of cure rates, and defines subsequent surveillance. This chapter highlights an evolving technique - laparoscopic staging - for early ovarian cancer. This technique is restricted to selected cases and is performed by appropriately trained surgeons. In majority of patients with advanced ovarian cancer, the goal of laparotomy is to remove as much tumor as possible through a process of surgical cytoreduction in order to maximize response to chemotherapy, and improve survival.