are typically closed transversely using a Lembert suture technique to achieve the apposition of healthy bowel serosa [15]. A full-thickness small bowel injury involving less than 50% of the circumference is debrided back to healthy tissue and closed transversely to prevent nar­rowing of the lumen. Full-thickness bowel inju­ries are typically closed in two layers with the rst layer performed in an interrupted or run­ning fashion with care to take a healthy bite of serosa and a small bite of mucosa. A second layer of interrupted Lembert sutures is used to imbricate the rst layer. While techniques vary, when a bowel resection is required, our practice is to perform a stapled side-to-side (functional end-to-end) anastomosis with sutured or stapled closure of the common enterotomy. A single or two-layer hand-sewn anastomosis is also an appropriate option. The choice between the dif­ferent techniques is surgeon preference and there is no difference in complication rates between the two [16].

Experienced surgeons begin their approach to pelvic dissection by rst gaining proximal con­trol of the common iliac artery (CIA) with cir­cumferential control using a vessel loop to allow for better retraction as your dissection proceeds distally. Next, due to its overlying orientation to the common iliac vein (CIV) circumferential dis­section of the CIA is necessary to retract the artery laterally and expose the CIV.Once the CIA and CIV have been dissected out and controlled with vessel loops proximal and distal to the tumor, the dissection continues into the pelvis. As the pelvic dissection proceeds, care must be taken to control the branches of the ileopelvic arterio­venous system as these have the potential to become a signicant source of bleeding. Next, the internal iliac artery (IIA) and vein (IIV) and external iliac artery (EIA) and vein (EIV) are encountered. These vessels are dissected out and circumferential control is once again obtained using vessel loops. Depending on the extent of resection it may be safe to proceed with ligation and transection of the IIA with a stapler or a suture ligature. Early division of the IIA allows for exposure to the IIV and its draining branches. These branches lie lateral to the IIA and can be accessed and easily ligated with the exposure cre­ated from the early division and retraction of the IIA.It is important to ligate the venous branches draining into the IIV prior to its ligation and divi­sion. If the IIV remains distended after the branches are ligated, you should be suspicious that there is a posterior branch that will need to be ligated prior to division. The inability to account for this may lead to unexpected bleeding that is often difcult to control. Ligation of the IIV will not typically result in any decit. However, if ligation of both the EIV and IIV or the CIV is necessary due to tumor involvement, lower extremity edema may be signicant postopera­tively. However, this tends to be self-limited if collateral drainage is preserved during the dissection.