. Gynecology : . y attached, and openedsufficiently to admit the end of a pair of blunt curved scissors, which are pushedunder the peritoneum to the cut surfaces on each side of the uterus (Fig. 374).This dissects up the peritoneum so that it is easily cut, with the complete avoid-ance of bleeding. It is not necessary to dissect a flap of peritoneum on the posteriorwall of the uterus. The uterus is now ready for amputation. A half-length clamp is appliedto the left uterine vessels, where they ascend the uterus at the level of the 716 GYNECOLOGY internal os. A second, toothed, clamp- is applied
. Gynecology : . y attached, and openedsufficiently to admit the end of a pair of blunt curved scissors, which are pushedunder the peritoneum to the cut surfaces on each side of the uterus (Fig. 374).This dissects up the peritoneum so that it is easily cut, with the complete avoid-ance of bleeding. It is not necessary to dissect a flap of peritoneum on the posteriorwall of the uterus. The uterus is now ready for amputation. A half-length clamp is appliedto the left uterine vessels, where they ascend the uterus at the level of the 716 GYNECOLOGY internal os. A second, toothed, clamp- is applied to the same vessels f inchhigher on the uterine wall, and the vessels are severed close to the second clampso as to leave the proximal stump as long as possible. The traction forceps onthe fundus of the uterus is then seized in the left hand of the operator anddrawn as sharply to the right as possible in order to expose the cervix and giveroom for the amputation. A wedge-shaped incision is made across the cervix. Ot unite of \ and \. VlouncL \ TlctUi Urti- Vi P. Graves Fig. 375.—Supravaginal Hysterectomy. First Step of uterine vessels, having been exposed, are grasped with two clamps and are being must be taken to leave the ends of the vessels sufficiently long above the lower clamp so thatthey may easily be seized by the secondary defense clamp seen in Fig. 379. until the cervical tissue is entirely severed. The uterus is now held only by theright uterine vessels (Fig. 377). They are clamped and cut so as to leave a longpedicle beyond the clamp. With the removal of the uterus and appendages onlytwo clamps remain in the pelvis controlling the uterine vessels. A third, toothed,clamp is now attached to the posterior lip of the cervical stump for the purposeof traction. K there is any question about the possibility of infection from HYSTERECTOMY OPERATIONS 717 the cervical canal, it may be cauterized or treated with crude carbolic acid oralcohol or i
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