Once the ileocolic pedicle is clearly identified, create a small window inferior to pedicle.

The window can be created bluntly or sharply, but avoid deep incisions or heat to protect the retroperitoneal structures. After creating the window, allow the pneumoperitoneum to open and aid in developing the retroperitoneal plane. With the window made, use the triangulation technique to develop the retroperitoneal plane (Fig. 12.3). With the left hand, place the grasper deep in the mesenteric rent and maintain firm upward traction to form the apex of the triangle. With the right hand, sweep the tissue down to delineate the retroperitoneal dissection plane.

Continue developing the retroperitoneal plane through the triangulation technique under the ascending colon and up to the hepatic flexure, moving the left hand deeper, and brushing the retroperitoneum down laterally. Identify the duodenum and carefully sweep it down toward the retroperitoneum. Identify the right branch of the middle colic artery coursing above the duodenum on the right lateral wall of the dissection plane. Continue the dissection following the lateral border of the duodenum superiorly toward the liver.

With the freedom from dividing the ileocolic pedicle, continue the dissection of the retroperitoneal plane. The borders of retroperitoneal dissection are Gerota’s fascia (deep), the lateral plane of duodenum (medial), the transverse colon (superior), and the right colon (laterally).

During the retroperitoneal dissection, complete further dissection around the right branch of the middle colic artery and divide it (Fig. 12.4). Our choice is to use an energy source for ligation. Take care to ensure the duodenum is down and away from the field when performing the ligation. Alternatively, with an umbilical extraction site, the right branch of the middle colic vessel can be ligated extracorporeally.