After the incision, lateral abdominal wall muscles, including the external oblique muscle, the internal oblique and transversus abdominis muscles are divided with electrocautery. The dissection is usually lateral in the left lower quadrant and effort is made to enter retroperitoneum at the lateral border of the rectus sheath. This is done to minimize the risk for entering the peritoneal cavity. The inferior epigastric vessels are preserved usually or ligated if extension of the incision is required.
Blunt digital dissection is used to free the peritoneum laterally and posteriorly from the overlying muscle fascia and muscle fascia is divided along the incision. The peritoneum is retracted medially and superiorly to identify the psoas muscle. The dissection is continued and left ureter is identified. The ureter is then retracted laterally and dissection is extended to left common iliac artery and renal pelvis. This helps in the identification of gonadal vein.
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