An elliptical incision is made with cutting cautery. The incision extends anteriorly from the mid-portion of the perineal body in males or the posterior area of the vagina in females to the plane of coccyx tip. Such an incision is made in a conventional situation. If resection of the vagina is planned, the elliptical incision is extended anteriorly to incorporate the posterior area of vagina. The initial incision is deepened down through the fat of both ischiorectal fossae to the level of the levator ani muscles laterally. The inferior rectal vessels can be controlled by coagulation or suture ligation. Self-retaining or rake retractors facilitate the exposure.
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