Gynecology . ttached theupper end of the vagina. THE MAYOS OPERATION FOR PROCIDENTIA An operation for procidentia combining the principles of the Watkins andGoffe operations is that devised by the Mayos. A vaginal hysterectomy is performed as described on page 628, exceptthat clamps are used on the broad ligaments instead of ligatures. The edgesof the broad ligaments are then approximated laterally, and a running mattresssuture of chromicized catgut passed through both ligaments, along a line suffi- 39 610 GYNECOLOGY ciently far back of the clamps so that when drawn taut the broad ligaments ar
Gynecology . ttached theupper end of the vagina. THE MAYOS OPERATION FOR PROCIDENTIA An operation for procidentia combining the principles of the Watkins andGoffe operations is that devised by the Mayos. A vaginal hysterectomy is performed as described on page 628, exceptthat clamps are used on the broad ligaments instead of ligatures. The edgesof the broad ligaments are then approximated laterally, and a running mattresssuture of chromicized catgut passed through both ligaments, along a line suffi- 39 610 GYNECOLOGY ciently far back of the clamps so that when drawn taut the broad ligaments aretightened (Fig. 312). This mattress stitch runs at a distance of 1 to 1| inchesfrom the edges of the ligaments, and is designed also to secure the vessels withoutpossibility of slipping. The upper border of the united broad ligaments is then stitched to thevaginal wall at the level of the upper angle of the vaginal wound. This compelsthe bladder to rest on the broad ligaments as on a kind of shelf. The loose. Fig. 314.—Spinellis Operation for initial incision. edges of the broad ligament are now stitched smoothly together, and the vaginalflaps closed by a running suture (Fig. 313). CONSERVATIVE OPERATION FOR INVERSION OF THE UTERUS The technic of the operation devised by Kiistner for inversion is as follows:A wide transverse incision is made opening the pouch of Douglas. Theforefinger of the left hand is introduced through this incision into the cup-shaped depression caused by the inversion of the fundus. If the uterus can be OPERATIONS FOR UTERINE MALPOSITION 611 brought outside of the vulva, the inverted fundus will appear uppermost, theposterior aspect of the uterus and cervix being toward the operator. A longi-tudinal incision is then made exactly in the middle line, dividing the posteriorwall of the cervix and a part of the posterior wall of the fundus. With the fore-finger in the cup-shaped depression on the abdominal side, and the thumb on thefundus of t
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