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So as this patient has taken final anesthesia we'll first check whether she is fully anesthetized

2
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by pinching with forceps and then go to the skin incision

3
00:00:11,244 --> 00:00:17,026
where in this case it is

4
00:00:17,026 --> 00:00:22,087
? a final style incision which you see is a lower transverse skin incision

5
00:00:22,087 --> 00:00:27,002
with a, we also have other types of lower midline or other incisions

6
00:00:27,002 --> 99:59:59,999
and this incision is done around around 3 centimeters above the symphasis pubis,

7
99:59:59,999 --> 99:59:59,999
and it carving an incision in the, width of the incision will depend on the estimated xxx of the xx site

8
99:59:59,999 --> 99:59:59,999
and after the skin, we'll cut through the subcutaneous fat, which after cutting in the middle we cut bluntly dissect using our fingers

9
99:59:59,999 --> 99:59:59,999
and then the next step would be after the subcutaneous fat we'll go to the rectus sheath, where we'll cut

10
99:59:59,999 --> 99:59:59,999
using our knives, and then to widen the rectus sheath we can either use sharp dissection using our knife by x the recus sheath by using our foceps or

11
99:59:59,999 --> 99:59:59,999
using blunt dissection but it should be carving the ab x dissection to avoid bleeding

12
99:59:59,999 --> 99:59:59,999
and then we'll bluntly dissect the rectus abdominus muscle

13
99:59:59,999 --> 99:59:59,999
but before that, what we usually do that we don't see here is we try to cut and relieve the rectus sheath from the rectus abdominus at the midline from the median raffe

14
99:59:59,999 --> 99:59:59,999
and then we'll, the next step we'll reach at the peritoneum, and we'll have to pick up the peritoneum slightly higher to avoid the bladder injury

15
99:59:59,999 --> 99:59:59,999
and then after making sure that we have not clamped bowel, we'll cut with a knife

16
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or with a scissor to cut open the peritoneum and enter into the abdominal cavity

17
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and then we'll insert our x bladder retractor after we open the abdominal cavity