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the patient is a 32 year old G1 P1 with a large symptomatic uterine fibroid a pre-operative MRI characterized the fibroid as fundal sub-zerosal Figo type 7 measuring 17 centimeters a mail-out incision is planned which increases exposure and access to the pelvic side walls compared to a fan and steel incision while allowing for a transverse skin incision transverse incisions have lower post-operative pain hernia formation and adhesions compared to midline incisions since the fascia is open to the lateral borders of the rectus muscle to expose the inferior epigastric vessels the risk of iliohypogastric and ilioinguinal nerve injury is increased therefore a higher skin incision will avoid injury to these nerves which are more lateral in this location the patient is positioned in dorsal lithotomy the abdomen is entered using a maillard incision the skin and fascia are opened horizontally the inferior epigastric arteries are then identified at the lateral border of the rectus sheath skeleto
