Operative gynecology : . ne patient, after removing a large cancerous uterus, I found aseparate mass in the left broad ligament, which I proceeded to enucleate with 610 VAGINAL HYSTEEECTOMY. forceps and scissors, actually dissecting it off from the ureter, which was baredfor cm. (3 inches), without injury, it being plainly denned the whole timeby a bougie mm. ( inch) in diameter. Moderate traction may be made upon the ligature when tied, assisting inexposing the area to be divided by the scissors; but as soon as the division iseffected all traction must cease at once, lest the ligat
Operative gynecology : . ne patient, after removing a large cancerous uterus, I found aseparate mass in the left broad ligament, which I proceeded to enucleate with 610 VAGINAL HYSTEEECTOMY. forceps and scissors, actually dissecting it off from the ureter, which was baredfor cm. (3 inches), without injury, it being plainly denned the whole timeby a bougie mm. ( inch) in diameter. Moderate traction may be made upon the ligature when tied, assisting inexposing the area to be divided by the scissors; but as soon as the division iseffected all traction must cease at once, lest the ligatures be pulled off. Theiiterine artery should be included in the second or third ligature applied. Assoon as the peritoneum is opened the index finger will find the artery pulsatingbeside the cervix near the internal os. Its exact position once fixed serves as aguide in estimating the amount of tissue to be included in the ligatures in orderto catch it in the second or third. The artery, when laid bare, is easily distin-. Fig. 349.—Vaginal Hysterectomy. The cervix and uterus pulled well over to the left. The right broad ligament has been tied all theway up to the top, which will be tied next. The index finger is hooked behind the top of the broadligament, pulling it down into view for the application of the last ligature. The round ligament andthe tube are seen at their uterine ends. gnished as a large, white, tortuous trunk with a lumen 2 or 3 mm. in diameter,strongly pulsating on its proximal side. As soon as the uterine arteries of oneside are secured and severed from the uterus the operator continues to tie offthe remainder of the broad ligaments on that side up to the top. When near OPERATION. 611 the top of the broad ligament the finger is passed over the tube close to theuterine cornu, which is hooked down into view and tied. If the cancer affects the body of the uterus, or there is a pyosalpinx or otherpelvic inflammatory disease complicating it, the ligatures should
Size: 1572px × 1588px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, booksubjectgynecology, bookyear1
