Traversing internal oblique

The internal oblique muscle and aponeurosis should be revealed deep to external oblique. It is traversed with care:

• the edge of the rectus sheath should lie medially within the wound
• it is gripped superiorly and inferiorly with two tissue forceps and raised up away from the peritoneal cavity
• a small, superficial transverse incision is made through the sheath between the forceps
• large artery forceps are directed through the incision in a medial direction; the jaws are opened in the depth of the incision to expose transversus abdominis and deeper extraperitoneal fat

Retractors are placed into the wound to gain improved exposure. Once extraperitoneal fat is visible, blunt dissection can be used to sweep it away from the peritoneum.