. A manual of gynæcology and pelvic surgery, for students and practitioners. ectomy is at least double that forsupra-vaginal amputation, the latter achice seems somewhattoo radical. The technique of complete hysterectomy is rendered lessdifficult by severing the cervico-vaginal junction through thevagina before the abdominal portion of the operation is advantage gained in this way is not sufficient to justify itsadoption as a routine measure, but if a cystocele or relaxedvaginal outlet needs correction it may be well to precedethe required plastic work by this incision. In case the o
. A manual of gynæcology and pelvic surgery, for students and practitioners. ectomy is at least double that forsupra-vaginal amputation, the latter achice seems somewhattoo radical. The technique of complete hysterectomy is rendered lessdifficult by severing the cervico-vaginal junction through thevagina before the abdominal portion of the operation is advantage gained in this way is not sufficient to justify itsadoption as a routine measure, but if a cystocele or relaxedvaginal outlet needs correction it may be well to precedethe required plastic work by this incision. In case the opera-tion is performed entirely from above the technique is the sameas for supra-vaginal amputation up to the point of severing 332 OPERATIONS UPON THE UTERUS AND ITS LIGAMENTS the body of the uterus from the cer\dx. A very simple methodof completing the operation consists in amputating the uterusand then dissecting the cervical stump from its attachmentsto the broad ligaments and vagina. Usually, however, it isbetter to proceed without separate removal of the body of the. Fig. 173.—Pan-hysterectomy. Anterior view. The tops of the broad liga-ments clamped and cut. The bladder is stripped from the cervix and upperportion of the vagina. uterus, and strip the bladder from the entire anterior cervicalwall and upper portion of the vagina. The uterus is drawnwell forward over the pubes and the sacro-uterine ligamentsnoted. These ligaments and the peritoneum between themare severed transversely, and the connective tissue separating PAN-HYSTERECTOMY 333 the peritoneum from the posterior vaginal wall is picked up andcut across, the incision extending into the vagina if this has notbeen done from below. Two fingers are now introduced intothe vagina through this opening, passed anteriorly beneath thecervix, and made to impinge upon the anterior vaginal wallbetween the bladder and the cervix, when a transverse incision
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