Gynaecology for students and practitioners . ^^H y^^^l ^nnv^B ^^^^^^^H|^^^^^B^3^^i^ ^^sk. ^^^ jU^^Bg^^^ *^^^ ?^i^^hI fm a^l ^^ P^ Fig. 430. Abdominal Total Hysterectomy eor Cancer of artery divided. Ureter exposed in the whole of its pelvic course. tied the artery is divided, when a complete view of the exposed uretercan be demonstrated along the whole of its pelvic course (see Fig. 430).The ureter is now rolled off the cervix and side of the vagina with agauze swab. The same procedure is carried out on the opposite side.(Should any glands be met with between, or overlying, the
Gynaecology for students and practitioners . ^^H y^^^l ^nnv^B ^^^^^^^H|^^^^^B^3^^i^ ^^sk. ^^^ jU^^Bg^^^ *^^^ ?^i^^hI fm a^l ^^ P^ Fig. 430. Abdominal Total Hysterectomy eor Cancer of artery divided. Ureter exposed in the whole of its pelvic course. tied the artery is divided, when a complete view of the exposed uretercan be demonstrated along the whole of its pelvic course (see Fig. 430).The ureter is now rolled off the cervix and side of the vagina with agauze swab. The same procedure is carried out on the opposite side.(Should any glands be met with between, or overlying, the vessels theseshould be removed. It is often necessary to do so before the ureterscan be exposed.) The uterus during the next stage of the operation is I 756 di-awn up and carried forwards. The utero-sacral folds are clampedand divided, the peritoneum at the back of the ragina is cut across andthe rectum pushed back. Xext the parametric tissues on both sidesare clamped vrith specially strong forceps devised by Wertheim for the. Fig. Abdomcsal Total Hysterectomy foe Ca>^cek oe clamp applied. (The parametric clamps are omitted for greater clearness.) purpose {see Fig. 432). \Yhen the bases of the broad Hgaments aredivided, the uterus is drawn forcibly upwards in the direction of theupper angle of the wound and the vaginal clamps applied {see ). Before so doing it is necessary to raise the bladder with a wide flatretractor, and at the same time to define the ureters as they enter that TOTAL ABDO:XAL HYSTERECT0:MY 757 viscus. Thev must lie well outside the curve of the clamps. After thevaginal clamps have been tightly closed the vagina is am^putated belowtheir grip, and the uterus with the cervix enclosed in a vaginal capsuleis thus freed and can be removed. The edges of the vagina are now Fig. 4:o2. Abdoajis^al Total Hysterecto3it foe Ca2s-cee of removed. The vaginal walls are held up and brought into appositionbv three long
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
