. Operative gynecology. l be surprised to note the considerable cellular intervalwhich often separates them as they arc exposed in this way. It is best not to clamp them as soon as seen, but to pull the uterus up fur-ther until the separation between the cut surfaces amounts to several centime-ters. At this higher level the artery, at first not so plainly seen, comes clearlyinto view and may be clamped by itself, the uterus rolled still more over on itsside, and the round ligament clamped close to it and divided, and finally, with alittle more traction, the ovarian vessels are seen and clamped
. Operative gynecology. l be surprised to note the considerable cellular intervalwhich often separates them as they arc exposed in this way. It is best not to clamp them as soon as seen, but to pull the uterus up fur-ther until the separation between the cut surfaces amounts to several centime-ters. At this higher level the artery, at first not so plainly seen, comes clearlyinto view and may be clamped by itself, the uterus rolled still more over on itsside, and the round ligament clamped close to it and divided, and finally, with alittle more traction, the ovarian vessels are seen and clamped and cut, and thewhole mass is finally freed and taken away. 372 MYOMECTOMY—HYSTEKO-MYOMECTOMY. The uterine veins often do not bleed when severed in this way ; if they do,it is easy to control them with one or two pairs of forceps. Ligating the Vessels controlled by Forceps.—As soon asthe uterus, with the tumor, is lifted away the operator looks over the wholefield to see that there is no active hemorrhage going Fig. 499.—The Last Step in the Enucleation of the Mtomatods mass is rolled out of the abdomen and is now attached only by the round ligament, ovary, and tube. He then proceeds to tie the vessels on the side controlled by forceps, takingup first the round ligament which is encircled with a catgut ligature ; next theovarian vessels are controlled by transfixing the clear space and tying them witha fine silk ligature. The uterine artery is now drawn up and tied at a pointwell above the cupped stump. This avoids any risk of tying the ureter. By grasping the cervical stump with a pair of tenaculum forceps it can bepulled up into the abdominal incision within easier reach, bringing with it theuterine vessels, which are then also under better control. Two ligatures should be placed upon every important vessel, the first tied inthe course of the enucleation and the second when the enucleation is completed. Suturing the Stump.—The next step is to close th
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectgenitaldiseasesfemal
