(1) After the anesthesia
is in full effect, the
surgeon makes the
first incision thru the skin.

(2) There are 7 specific layers of tissue to be incised. After the skin is opened, the surgeon must working down layer by layer, starting with fat and moving on to the rectus sheath (membrane encapsulating
 the muscle)

1
Low Transverse Abdominal Incision

2
after Incising the rectus sheath

(3 ) As the surgery goes forward, bleeding vessels must be either tied off with a loop of suture or caterized (hot metal probe that seers and seals arteries and veins).

(4) After the skin, fat and muscle are out of the way, the sterile abdominal cavity must be carefully opened with surgical scissors.

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3
peritoneum incised and
abdominal cavity exposed

 4
Rectus sheath dissected and
cut free of the rectus muscle