. Operative gynecology. The operator then washes his hands thoroughly, and proceeds to control thevaginal vessels by j)assing as many catgut ligatures as are needed for the purposethrough the outer tissues of the vagina in a direction perpendicular to its long axis. The pelvis is now carefully examined for other enlarged glands either lyingon or under the iliac vessels, at the bifurcation of the common iliac artery, orjust above it. Wherever these are found they should be removed. Enlargedglands lying upon the internal or external iliac veins can often be removed onlywith extreme care and by p
. Operative gynecology. The operator then washes his hands thoroughly, and proceeds to control thevaginal vessels by j)assing as many catgut ligatures as are needed for the purposethrough the outer tissues of the vagina in a direction perpendicular to its long axis. The pelvis is now carefully examined for other enlarged glands either lyingon or under the iliac vessels, at the bifurcation of the common iliac artery, orjust above it. Wherever these are found they should be removed. Enlargedglands lying upon the internal or external iliac veins can often be removed onlywith extreme care and by painstaking dissection. In one instance I found thegland semilunar in form and closely pressing upon the external iliac vein whose OPERATION FOR ABDOMHSTAL HYSTETECTOilY FOR CANCER. 329 form it liad taken; it was only detaclied by a minute slow dissection, but theseparation was finally satisfactorily made. If a vein is torn off at its point ofentrance into the external or common iliac veins the opening should be closed. Fig. 470.—After freeing the bladder and dissecting out the left broad ligament, the vaginal vault isopened anteriorly and all hemorrhage controlled by a series of sutures placed as shown in the figure. Thebladder and ureters, with bouj^ies, are shown in dotted outlines. by a fine suture with a fine needle, folding the wall of the vein upon itself, inthis way avoiding the necessity of ligating the large trunk with the attendantrisk of gangrene below it. A thorough ins]jection of the whole area exposed and of all the ligaturesapplied to important vessels is now made as a distinct and most important stepm the opei-ation ; in this inspection the operator should assure himself as far aspossible as to the thoroughness with which the disease has been extirpated, heshould discover any persistently bleeding points and control them with liga-tures, and, above all, he should see that all the large vessels are securely tied andshould reinforce any doubtful ligatures. The a
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectgenitaldiseasesfemal
