. Gynecology : . ncer of the uterine vessels of both sides have been ligated and tied and the ureters exposed. Therecto-uterine reflection of peritoneum has been divided. The uterosacral ligaments have beenclamped and are being severed. The paravaginal tissue is exposed. the uterine mass being more and more released at each cut. At this stage, beforefinally clamping and removing the mass, the bladder, especially at the pointsof entrance of the ureters, can be still further separated from the vagina. (6) Clamping and Amputation of the Vagina.—When the dissection has beencarried down
. Gynecology : . ncer of the uterine vessels of both sides have been ligated and tied and the ureters exposed. Therecto-uterine reflection of peritoneum has been divided. The uterosacral ligaments have beenclamped and are being severed. The paravaginal tissue is exposed. the uterine mass being more and more released at each cut. At this stage, beforefinally clamping and removing the mass, the bladder, especially at the pointsof entrance of the ureters, can be still further separated from the vagina. (6) Clamping and Amputation of the Vagina.—When the dissection has beencarried down the vagina as far as possible, always to a considerable distancebelow the site of the cancer, the vagina is to be amputated. It is an excellent 742 GTXECOLOGT safeguard at this point to insert on each side of the vagina, just below the levelof the proposed line of amputation, strong catgut ligatures, the ends of whichare left long and clamped. These ligatures serve as tractors to prevent the ^2>\obbet SuXure. V/.T?£ Fig. 402.—Webtheims Opeeatiox for Caxceb of the Cervix. The uterus and vagina have been freed. Traction sutures have been applied to the vaginal wall to hold it into view after amputation. The authors special clamp has been applied to the vagina the seat of the growth. Wertheirn clamps have been applied below. These latter may be & if there is deficient vaginal margin. Amputation is made between the clamps with knife or cautery. retraction of the vaginal stump after amputation, and also to control the bleed-ing which is apt to come from the vaginal angles. In order to prevent the escape from the cancerous field of possible infectious HYSTERECTOMY OPERATIONS 743 material the vagina must be effectively shut off for its entire width. To accom-plish this numerous clamps have been devised, notably the right-angled clampsof Wertheim. Berkeley and Bonney use a large T-clamp. which appears to bean excellent device. In the drawing i Fig. 402) the vagina is clamped ab
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