. Gynecology : . eon to change gloves and instrumentsafter removing the gauze placed for protection of the pelvis. VAGINAL HYSTERECTOMY As compared with a properly executed abdominal hysterectomy, the extir-pation of the uterus per vaginam has no advantages. It cannot be done morerapidly, and there is no less shock or loss of blood, though claims to the contraryare sometimes made. Vaginal hysterectomy is useful in some types of operationfor procidentia. Steps of the Operation.—The cervix is grasped by a traction forceps anddrawn firmly down toward the introitus. A cross-incision is made at the
. Gynecology : . eon to change gloves and instrumentsafter removing the gauze placed for protection of the pelvis. VAGINAL HYSTERECTOMY As compared with a properly executed abdominal hysterectomy, the extir-pation of the uterus per vaginam has no advantages. It cannot be done morerapidly, and there is no less shock or loss of blood, though claims to the contraryare sometimes made. Vaginal hysterectomy is useful in some types of operationfor procidentia. Steps of the Operation.—The cervix is grasped by a traction forceps anddrawn firmly down toward the introitus. A cross-incision is made at the lineof junction of the bladder and anterior cervical wall. The bladder is thenstripped from the cervix and the uterovesical pouch opened. The traction for-ceps is removed from the cervix, and the cervix .is itself pushed back in the HYSTERECTOMY OPERATIONS 729 vagina, so as to antevert the uterus. The fundus is thus brought into view,seized with volsella, and brought out through the opening in the uterovesical. Fig. 390.—Vaginal- Hysterectomy. Transverse incision of the vaginal wall at the junction of bladder and cervix. Stripping back the bladder (adapted from Doderlein-Kronig). pouch. Mass ligatures are now placed on the broad ligament, including theround ligament tube and suspensory ligament of the ovary, which aresevered near the uterus. The parametrium is divided on the sides of the 730 GYNECOLOGY uterus, thus exposing the uterine vessels, which are tied and cut. Severalstitches are placed in the stump of the parametrium on each side, attachingit to the sides of the vaginal wound. The uterus is now drawn strongly forwardand the pouch of Douglas exposed. With the uterus in this position the pos-terior wall of the vagina is easily divided. During this incision there is
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