A self-retaining retractor was used to separate the brachioradial and flexor carpal muscles, and a silicone elastomer vessel loop was placed around the RA pedicle to include the RA vena communicantes and fatty areolar tissue.
The vaginal mucosa is then dissected off the underlying rectovaginal septum distally and any enterocele proximally In the upper third of the vagina, lateral dissection is extended in the pararectal space until areolar tissue is encountered.
It includes not only tendons and ligaments, but also areolar tissue which connects other tissues and organs, adipose tissue which provides insulation, support and a reserve food supply, and cartilage which is found in many places in the body but most notably in articular structures such as vertebral disks.
It contains a quantity of loose areolar tissue, some lymphatic vessels which ascend from the convex surface of the liver, two or three anterior mediastinal lymph glands, and the small mediastinal branches of the internal mammary artery.
The cavitation effect created by the rapidly moving instrument tip (55,500 cycles/second) creates tissue separation along the areolar tissue planes, where most blood vessels are the size of capillaries and where larger blood vessels are easily identified and controlled by coaptation, coagulation, and cutting.