Gynaecology for students and practitioners . ed on the left-hand side of diagrams. division, the peritoneal flap is pushed down, together with the upperpart of the bladder, by means of a swab in a holder. It will be foundnecessary to use a few snips with scissors in order to free the bladderin the midline. The left uterine vessels are next exposed, and isolatedby passing a dissector between the vessels and the side of the cervix 744 GYNECOLOGY and running it up and down between the two. The isolated vessels arenow clamped in two places about one inch apart with stout arteryforceps and then cut
Gynaecology for students and practitioners . ed on the left-hand side of diagrams. division, the peritoneal flap is pushed down, together with the upperpart of the bladder, by means of a swab in a holder. It will be foundnecessary to use a few snips with scissors in order to free the bladderin the midline. The left uterine vessels are next exposed, and isolatedby passing a dissector between the vessels and the side of the cervix 744 GYNECOLOGY and running it up and down between the two. The isolated vessels arenow clamped in two places about one inch apart with stout arteryforceps and then cut across. The appendages and vessels upon theright side are dealt with in the same manner, and when this is donethe uterus is attached only by the cervix and by the peritoneum ofthe posterior uterine wall. The amputation through the cervix ismade low down, to effect which, the uterus is drawn well up by theoperator, who takes a swab in a holder and with it rolls the bladderdownwards and the uterine vessels outwards. Then, with a scalpel, a 1. Fig. 420. Mode of Closure of the Peritoneum in the Pelvic Floor. V-shaped incision is made from front to back, the anterior cut runningdownwards and backwards through the bared cervix, and the posteriorcut running downwards and forwards through peritoneum and the amputation is complete, the assistant grasps the cervical stumpwith a volsella, and when the uterus and tumour are removed, the stumpis drawn up and the cervical endometrium painted with iodine. Theoperator then inserts one or two mattress-sutures of catgut throughthe shelving cervical flaps. Some surgeons scollop out the core of thecervix leaving only a shell—this is not necessary ; other scrape out or cutaway the cervical endometrium—this also is superfluous. When thecervical flaps are brought into apposition by suture, the latter areleft long and the volsella removed. The uterine vessels are next tiedoff by inserting a ligature behind the clamp in each case. Th
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
