Gynecology . neum isclosed and a gauze packing left in the opening above the vaginal wound. The convalescence is a long one owing to the time taken for healing of thevaginal wound. MYOMECTOMY OPERATIONS ABDOMINAL MYOMECTOMY In performing the operation for enucleation of uterine myomata the ab-dominal incision must be made sufficiently large to admit of convenient handlingof the pelvic organs. The fundus of the uterus is seized with double hooks MYOMECTOMY OPERATIONS 651 and drawn toward the abdominal wound into such a position as will expose bestthe myoma to be removed. It is often advantageou
Gynecology . neum isclosed and a gauze packing left in the opening above the vaginal wound. The convalescence is a long one owing to the time taken for healing of thevaginal wound. MYOMECTOMY OPERATIONS ABDOMINAL MYOMECTOMY In performing the operation for enucleation of uterine myomata the ab-dominal incision must be made sufficiently large to admit of convenient handlingof the pelvic organs. The fundus of the uterus is seized with double hooks MYOMECTOMY OPERATIONS 651 and drawn toward the abdominal wound into such a position as will expose bestthe myoma to be removed. It is often advantageous to insert a second pair ofdouble hooks into the uterine wall immediately below the lower pole of thetumor, traction on which lifts the uterus so that the field of operation is morein a horizontal plane. An incision through the wall of the uterus is madeparallel with the axis of the uterus over the most prominent part of the incision is carried down to the surface of the myoma, which can usually be. sA(.~^oA>eS Fig. 358.—Abdominal for a myoma in the posterior uterine wall. recognized by the difference in direction of its fibers from those of the uterinewall. When the surface of the myoma has been exposed the tumor is graspedwith a pair of double hooks carried deeply into the tissue. With firm tractionon the double hooks the tumor can then be readily shelled out by means ofsome blunt dissecting instrument, a pair of blunt-tipped curved scissors beingespecially useful. The enucleation is done carefully to prevent too great lacera-tion of the tissue of the uterine wall and to avoid, if possible, opening the uterinecavity- 652 GYNECOLOGY If the tumor happens to be an adenomyoma it cannot be shelled out in thisway, growing as it does diffusely in the wall of the uterus. Under these circum-stances the tumor must be dissected away from the uterine tissue, from whichit cannot always be clearly differentiated. When the myoma has been removed, there
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