Gynaecology for students and practitioners . tines out of the pelvic cavity. The advantage of applying the rubbersheeting first, is that it does not stick to the intestines. The uterushaving been drawn up, the appendages are examined, in order todecide whether it is necessary to remove one or both ovaries. In acase where both ovaries may safely be left in situ, the amputation ofthe uterus through the cervix proceeds as follows : The operator draws the uterus and tumour to the right side. Theleft round ligament is divided between two clamps. A second pair ofclamps is then applied to the remaini
Gynaecology for students and practitioners . tines out of the pelvic cavity. The advantage of applying the rubbersheeting first, is that it does not stick to the intestines. The uterushaving been drawn up, the appendages are examined, in order todecide whether it is necessary to remove one or both ovaries. In acase where both ovaries may safely be left in situ, the amputation ofthe uterus through the cervix proceeds as follows : The operator draws the uterus and tumour to the right side. Theleft round ligament is divided between two clamps. A second pair ofclamps is then applied to the remaining structures arising fromthe cornu, viz. to the Fallopian tube and to the ligament of theovary, and these tissues are divided between them. The assistantthen raises the peritoneum of the utero-vesical pouch with toothed SUBTOTAL HYSTERECTOMY 743 dissecting forceps, and the operator inserts one blade of the scissorsunder the peritoneum, and divides the fold from left to right, closeto and across the front of the isthmus of the uterus. After. Fig. 419. Fig. A (1) Round ligament; (2) Fallopian tube and ovarian ligament; (3) corner of cervical stump. Fig. B shows (1) and (2) united. Fig. C shows (1), (2), and (3) united on the left-hand side of diagrams. division, the peritoneal flap is pushed down, together with the upperpart of the bladder, by means of a swab in a holder. It will be foundnecessary to use a few snips with scissors in order to free the bladderin the midline. The left uterine vessels are next exposed, and isolatedby passing a dissector between the vessels and the side of the cervix 744 GYNECOLOGY and running it up and down between the two. The isolated vessels arenow clamped in two places about one inch apart with stout arteryforceps and then cut across. The appendages and vessels upon theright side are dealt with in the same manner, and when this is donethe uterus is attached only by the cervix and by the peritoneum ofthe posterior uterine wall. The amputation thr
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
