. Gynecology : . of the uterus has been delivered. The broad ligament of the left side is about to be tied and cut. The parametrial tissue is excised as far away from the uterus as possible,there being some bleeding from the hemorrhoidal vessels that run to theuterosacral ligaments. (5) Removal of Uterus and Adnexa.—The fundus of the uterus is deliveredthrough the opening into the uterovesical pouch. This is accomplishedby passing the forefinger of the left hand into the pouch of Douglas andanteflexing the fundus by pressure from behind. The fundus is seized withstrong volsella and drawn sharp
. Gynecology : . of the uterus has been delivered. The broad ligament of the left side is about to be tied and cut. The parametrial tissue is excised as far away from the uterus as possible,there being some bleeding from the hemorrhoidal vessels that run to theuterosacral ligaments. (5) Removal of Uterus and Adnexa.—The fundus of the uterus is deliveredthrough the opening into the uterovesical pouch. This is accomplishedby passing the forefinger of the left hand into the pouch of Douglas andanteflexing the fundus by pressure from behind. The fundus is seized withstrong volsella and drawn sharply forward. In this way the broad ligaments 750 GYNECOLOGY are brought into view. The uterus is then drawn to the right, and withthe left forefinger as a guide a double ligature is applied on a ligature-carrierto the broad ligament. The round and infundibulopelvic ligaments are tiedand the uterus severed from the broad ligament. The same procedure is carriedout on the opposite side and the uterine mass \V?.Gvc\\>fcS s Fig. 411.—Schautas Operation For Cancer of the the peritoneal layer by a continuous stitch. The paravaginal wound is closed with deep sutures-. • The peritoneum isclosed and a gauze packing left in the opening above the vaginal wound. The convalescence is a long one owing to the time taken for healing of thevaginal wound. MYOMECTOMY OPERATIONS ABDOMINAL MYOMECTOMY In performing the operation for enucleation of uterine myomata the ab-dominal incision must be made sufficiently large to admit of convenient handlingof the pelvic organs. The fundus of the uterus .is seized with double hooks MYOMECTOMY OPERATIONS 751 and drawn toward the abdominal wound into such a position as will expose bestthe myoma to be removed. It is often advantageous to insert a second pair ofdouble hooks into the uterine wall immediately below the lower pole of thetumor, traction on which lifts the uterus so that the field of operation is morein a horizontal pl
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