In a medial-to-lateral technique, arm 4 is used to retract the terminal ileum/ cecum to elevate and apply tension to the ileocolic pedicle. The peritoneum below the ileocolic pedicle is incised using a fenestrated monopolar grasper in arm 1 and a bipolar scissor in arm 3 while holding the fatty tissue containing the vessels (Fig.26.5). This maneuver exposes the vascular pedicle for dissection, followed by the dissection, ligation, and division of the vessels (Fig.26.6). Following the dissec- tion, the superior mesenteric vein is observed with the presence of clips, as well as the middle colic vein with attached clips (Fig.26.7). The submesenteric dissection begins directly beneath the mesenteric opening. The dissection process is ongoing following the embryologic planes, revealing the retroperitoneal structures such as the duodenum, head of the pancreas, gonadal vessels, and right ureter (Fig.26.8). The dissection extends sideways to the abdominal wall, downward to the sacral promontory, and upward revealing the duodenum and head of the pancreas (Fredet fascia-anterior duodenopancreatic fascia). The identication of the pancreatic and colic branches of the gastrocolic trunk of Henle is conrmed (Fig.26.9).