. A manual of gynæcology and pelvic surgery, for students and practitioners. y be partially inverted by the dragging upon it of the growth,and the uterine wall may then be damaged or even is for this reason also that incision of the mucosa surroundingthe tumor is made below the pedicle, instead of through it, whenthe tumor is to be removed by blunt dissection. ABDOMINAL MYOMECTOMY Abdominal myomectomy has a rather circumscribed field ofusefulness and is applicable only to a limited class of cases forthe same reasons that apply to the vaginal operation. Evenwhen a fibroid of consi
. A manual of gynæcology and pelvic surgery, for students and practitioners. y be partially inverted by the dragging upon it of the growth,and the uterine wall may then be damaged or even is for this reason also that incision of the mucosa surroundingthe tumor is made below the pedicle, instead of through it, whenthe tumor is to be removed by blunt dissection. ABDOMINAL MYOMECTOMY Abdominal myomectomy has a rather circumscribed field ofusefulness and is applicable only to a limited class of cases forthe same reasons that apply to the vaginal operation. Evenwhen a fibroid of considerable size seems to be solitary, other ABDOMINAL MYOMECTOMY 313 very minute ones may be found in the uterine wall, and if onlythe large growth is removed these small seedlings may continueto grow and necessitate another operation later. Abdominal myomectomy also has a slightly higher mortalityrate than supra-vaginal hysterectomy. It is useful, however,in young women in whom the function of child-bearing shouldnot be interfered with if the tumors are moderate in size and. Fig. 157.—Abdominal myomectomy. The uterine wall is incised longitu-dinally, the incision penetrating into the tumor in order to demonstrate to acertainty the plane of the tumor capsule. limited in number, or if they are distinctly pedunculated. Ifthe tumor is pedunculated its pedicle may be excised close upagainst the uterine wall, the bleeding controlled by deep catgutsutures, and neighboring peritoneum drawn over the raw areaby means of Lembert sutures. If the tumor is sessile or in-terstitial, the wall of the uterus over the most prominent 314 OPERATIONS UPON THE UTERUS AND ITS LIGAMENTS portion of the tumor should be incised in the longitudinal axisof the uterus until the tumor is reached. Berkley and Bonneyadvise that in making this incision the knife penetrate a shortdistance into the tumor, the object being to give one an ideaas to the exact location of its true capsule. When the capsuleis demonstr
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