The bowel to be resected is held by an assistant while the surgeon creates small openings in avascular segments of the mesentery along the line of transection. Small vessels are clamped and tied with Dexon suture.
Note that the line of transection in the bowel is oblique rather than perpendicular. The blood supply to the small bowel is such that the antimesenteric border of the bowel can become ischemic if the vascular arcade supplying the edge of the resected bowel is transected perpendicularly. A second reason for transecting the bowel in an oblique rather than a perpendicular line is that an oblique transection will give a larger anastomosis and reduce the incidence of stricture formation.