An abdominal incision is made under sterile conditions on the ventral abdomen through the skin and underlying abdominal muscle. The full uterus is exteriorized and examined for pathology and abnormalities. A small incision is made directly into the uterine body and the puppies are passed through this hole. Once the puppies have been removed from the uterus, they are then passed to an assistant for resuscitation. During resuscitation, the puppies are checked for any birth defects (cleft palates, hernias, etc).
The uterine incision is closed and the uterus is flushed, cleaned, and evaluated for contractility. The abdominal incision is then closed in 3 layers.