Gynecology . Fig. 336.—Vaginal- incision of the vaginal wall at the junction of bladder and cervix,bladder (adapted from Doderlein-Kronig). Stripping back the pouch. Mass ligatures are now placed on the broad ligament, including theround ligament tube and suspensory ligament of the ovary, which aresevered near the uterus. The parametrium is divided on the sides of the 630 GYNECOLOGY uterus, thus exposing the uterine vessels, which are tied and cut. Severalstitches are placed in the stump of the parametrium on each side, attachingit to the sides of the vaginal wound. The
Gynecology . Fig. 336.—Vaginal- incision of the vaginal wall at the junction of bladder and cervix,bladder (adapted from Doderlein-Kronig). Stripping back the pouch. Mass ligatures are now placed on the broad ligament, including theround ligament tube and suspensory ligament of the ovary, which aresevered near the uterus. The parametrium is divided on the sides of the 630 GYNECOLOGY uterus, thus exposing the uterine vessels, which are tied and cut. Severalstitches are placed in the stump of the parametrium on each side, attachingit to the sides of the vaginal wound. The uterus is now drawn strongly forwardand the pouch of Douglas exposed. With the uterus in this position the pos-terior wall of the vagina is easily divided. During this incision there is. Fig. 337.—Vaginal the uterovesical space (after Doderlein-Kronig). some bleeding from the vaginal vessels, which should be controlled as theuterus is removed. The round ligaments are then sewed into the corners of thevaginal wound. This is an important step, for it prevents to some extent alater prolapse of the vaginal wall. The anterior and posterior vaginal walls areapproximated by interrupted catgut sutures. HYSTERECTOMY OPERATIONS 631 WERTHEIMS EXTENDED OPERATION FOR CANCER OF THE UTERUS The Wertheim operation is used both for cancer of the cervix and cancer ofthe body of the uterus. Its chief object is to remove with the uterus as muchof the parametrial tissue as possible and to include a wide margin of the vagina. The description of the operation given below applies to cancer of the cancer of the body the same technic may be applied, but the dissection ofthe parametrium and the vaginal margin need not be so extensive.
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