A Reference handbook of the medical sciences embracing the entire range of scientific and practical medicine and allied science . umbilicus. It is necessarj- to gothrough the pyramidalis muscle down to the pubiccartilage. If the woman be fat, the umbilicus is re-moved and the incision extended above this. Uponentering the abdomen the table is lowered into the exag-gerated Trendelenburg position. The intestines andomentum are gently taken from the pelvis and placed inthe abdomen, and the sigmoid llexure is straightened curvature of the loins upon each side of the spineabove the pelvic b
A Reference handbook of the medical sciences embracing the entire range of scientific and practical medicine and allied science . umbilicus. It is necessarj- to gothrough the pyramidalis muscle down to the pubiccartilage. If the woman be fat, the umbilicus is re-moved and the incision extended above this. Uponentering the abdomen the table is lowered into the exag-gerated Trendelenburg position. The intestines andomentum are gently taken from the pelvis and placed inthe abdomen, and the sigmoid llexure is straightened curvature of the loins upon each side of the spineabove the pelvic brim is carefully and accurately filledwith gauze pads, and other pads are used so as to makea complete dam across the body at the upper end of theincision, holding the intestines back. The table is nowraised so as to be almost horizontal. A careful survey ofthe field is made, but rapidly. I then pick up the ova-rian vessels of one side at the pelvic brim before theycross the external iliac artery and ligate them. Provi-sional ligatures are then applied near the ovaries. Thesame is done on the other side. The broad ligaments. Fig. 4916. -a Specimen of a Uterus RemoviHl iiv Vneinal Hysterectomv (by the forceps opera-tiou). The cervix, which was the seat of a cancerous growth in an early stape, is shownclosed by heavy silk sutures, which were employed to prevent soiling of the field of opera-tion by the contents of the uterus. (Pryor. i between are cut close to the first ligatures, which latterare cut short. The round ligaments are seized by arteryforceps, drawn out, ligaled close to the internal inguinalrings, and cut short. Beginning upon the right side theperitoneum is split upon a director from the point of the first cut, along the pelvic brim below the internal iliacartery, to the vesico-uterine fold. This having been doneon each side and the two cuts uniteil by a third acrossthe bladder at the vesico-uterine fold, the peritonealcovering of the organs to be removed is severed
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