. Operative gynecology. l incision made,varying in its length according tothe thickness of the abdominal walland the depth of the pelvis. As arule, the incision should extend onethird or one half way up to the um-bilicus, in order to give a perfect ex-posure of the pelvic viscera and toallow the operator to use his handswith entire freedom in all the man-ipulations necessary throughout theoperation. The enucleation is begun bygrasping the uterus and one tubeand ovary and di-awing them up-ward and out of the abdomen whenpossible, and ligating the ovarianvessels near the brim of the pelvis;the r
. Operative gynecology. l incision made,varying in its length according tothe thickness of the abdominal walland the depth of the pelvis. As arule, the incision should extend onethird or one half way up to the um-bilicus, in order to give a perfect ex-posure of the pelvic viscera and toallow the operator to use his handswith entire freedom in all the man-ipulations necessary throughout theoperation. The enucleation is begun bygrasping the uterus and one tubeand ovary and di-awing them up-ward and out of the abdomen whenpossible, and ligating the ovarianvessels near the brim of the pelvis;the round ligament is next ligatedand clamps applied to the ovarian vessels and round ligaments on the uterineside, after which the top of the broad ligament is opened by an incision madebetween the ligatures and clamps. If the case is one of cancer of the cervix theligatures may be safely applied at a point nearer to the uterus ; in advanced can-cer of the body, however, it is better to apply them well away from the uterus,. Fig. 466.—Diagkam showing why the Bougie Some-times REFUSES TO PaSS ON Up THE UkETEB IN CAR-CINOMA OF THE CeRVLX. The ureter ordinarily yields a little as the bouo:iepasses upward toward the kidney; this movement, hywhich it aecomraodates itself to tlie elasticity of thebougie, is prevented when the ureter is embedded in acarcinomatous mass, and, as a consequence, an angle isformed just at the entrance of the fixed portion, beyondwhich it difficult to coax the instrument. Sometimesthe ureter is markedly kinked in the neifjhborhood ofthe diseased area (see Fig. 468). It is still important,however, to insert the bou£ie as far as possible, as theposition of the point serves to locate the ureter. OPEEATIOiq FOR ABDOMINAL HYSXBRECTOMT FOR CANCER. 325 on account of the possibility of cancerous elements being contained in the lym-phatics of the upper broad ligament or in the round ligaments. Such a con-dition is well shown m Fig. 458. After opening the broad li
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectgenitaldiseasesfemal
