1. After incising the skin, the incision is deepened through the subcutaneous tissue with the deep knife or cautery pencil.
2. The fascia is nicked with the deep knife and incised using a curved Mayo dissecting scissors.
3. Grasping one edge of the fascial margin with two or more Kocher clamps, blunt dissection separates the fascia from the underlying muscle.
4. The muscle is divided manually. The peritoneum is then knicked with the deep knife, and the incision is lengthened with Metzenbaum scissors.
5. A self-retraining retractor is placed in the wound, with moist lap sponges to protect the wound edges; the surgeon will “pack the bowel” away from the uterus with additional moist warm Lap sponges, and the operating table is placed in slight Trendelenberg position.
6. The uterus is isolated by severing it from the uterine ligaments ans adnexa.
7. The round ligaments of the uterus are ligated, divided, sutured, and tagged with a hemostat.