Abdominal incision in the Pelosi technique

(A) A low transverse suprapubic skin incision is made with a scalpel. The subcutaneous tissue and rectus fascia are incised transversely with electrocautery knife; the subcutaneous tissue is not stripped from the fascia beyond what is needed to expose the cut edges of the fascia.
(B) The linea alba is exposed by pulling up the superior edge of the abdominal incision. The traditional dissection of the superior and inferior aspects of the fascia from underlying rectus and pyramidal muscles is not routinely performed.
(C) To expose the peritoneum, the rectus muscles are separated in the midline by vertical digital dissection.
(D) The peritoneum is opened by finger perforation.
(E) The peritoneal opening is then extended digitally by vertical and lateral traction. When the peritoneum cannot be perforated or stretched digitally, a scalpel or scissors can be used.
(F) The full thickness of the abdominal incision is then stretched transversely using the surgeon's fingers.