Gynaecology for students and practitioners . at rectangular spatula {see Fig. 459). The anterior lip of the cervix, steadied by long ligatures, is about to be divided in the mid-line with scissors. submucous fibroid, such as that shown in Fig. 214, p. 434, may bedealt with by the method next to be described. Vaginal Myomectomy by Morcellement. The foregoing descriptionof how to deal with intra-uterine polypi embraces the main principleswhich underlie the operation of vaginal myomectomy. A fullerdescription is necessary of the method of dealing with large submucous VAGINAL MYOMECTOMY 789 myomat
Gynaecology for students and practitioners . at rectangular spatula {see Fig. 459). The anterior lip of the cervix, steadied by long ligatures, is about to be divided in the mid-line with scissors. submucous fibroid, such as that shown in Fig. 214, p. 434, may bedealt with by the method next to be described. Vaginal Myomectomy by Morcellement. The foregoing descriptionof how to deal with intra-uterine polypi embraces the main principleswhich underlie the operation of vaginal myomectomy. A fullerdescription is necessary of the method of dealing with large submucous VAGINAL MYOMECTOMY 789 myomata by the vaginal route. These tumours frequently slough,and are then accompanied by a putrescent discharge, which rendersany attempt to remove the uterus per abdomen particularly , the cervix is frequently found to be opened up by suchtumours, and their most dependent part may lie in the a case where the cervix is not dilated, the operation ofvaginal myomectomy is carried out in the following way : An Auvards. Fig. 458. Vagesjal Myomectomy. The cervix has been split by a medianincision in its anterior wall ; the edges of the incision are transfixed and heldaside by traction on long stout ligatures. The lower pole of a submucousfibroid is exposed through the upper part of the wound. speculum is inserted to depress the perineum and the posterior vaginalwalls. The vagina is dilated laterally by Jayles self-retainingdilator {see Fig. 414, p. 736). The anterior lip of the cervix is graspedwith a volsella and is drawn down. A wide crescentic incision is nowmade through the vaginal mucosa in front of the reflection of thebladder. When necessary two lateral incisions may also be made,passing upwards and outwards from either angle of the transverse 790 GYNAECOLOGY incision, thus mapping out a tongue-shaped flap of vaginal mucousmembrane {see Fig. 449, p. 779). The limits of the bladder areindicated by the difference in appearance of the vaginal mucoussurf
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
