After the bowel has been freed from the hollow of the sacrum, the fingers of the left hand should separate the right ureter from the overlying peritoneum by blunt dissection (Figure 8). The peritoneum is incised some distance from the tumor, and the rectum is freed further down to the region of the levator muscles using the mesorectal dissection (Plates 70 and 71). Division of the middle hemorrhoidal vessels with the suspensory ligaments may be necessary to ensure the needed length of bowel to be resected below the tumor. The surgeon should not hesitate to divide the peritoneal attachments in the region of the pouch of Douglas, to free the rectum from the prostate gland in the male and from the posterior wall of the vagina in the female. The inferior mesenteric artery is freed from the underlying aorta to near its point of origin (Figure 9). Three curved clamps are applied to the inferior mesenteric artery, and the vessel is divided and ligated with 00 silk. The inferior mesenteric vein should be ligated at this time, before the tumor has been palpated and compressed due to the manipulation required during resection.