Gynecology . pted from Doderlein-Kronig). The uterus is then delivered, and a shortening of the round ligaments byreduplication performed through the vaginal opening. The principle involvedin this operation is to shift the bladder around on the uterus so as to form a newattachment not only in the median line, but also at the two cornua of thebladder. A description of the steps of the operation from this point is quoted fromGoffe: OPERATIONS FOR UTERINE MALPOSITION 607 The object of the next procedure is to carry up into the pelvis and to fixthe firm immovable base of the bladder. To accomplish
Gynecology . pted from Doderlein-Kronig). The uterus is then delivered, and a shortening of the round ligaments byreduplication performed through the vaginal opening. The principle involvedin this operation is to shift the bladder around on the uterus so as to form a newattachment not only in the median line, but also at the two cornua of thebladder. A description of the steps of the operation from this point is quoted fromGoffe: OPERATIONS FOR UTERINE MALPOSITION 607 The object of the next procedure is to carry up into the pelvis and to fixthe firm immovable base of the bladder. To accomplish this a point is se-lected in the middle of the base of the bladder wall which, when carried up tothe torn edge of the peritoneum on the anterior face of the uterus, middle point,will take up all the slack in the base of the bladder, making a comparativelystraight line from the urethra to the uterus. Through this point a suture ispassed and carried also through the selected point on the anterior face of the L. j-V)UruS ?to£r-^ Fig. 311.—Wertheims Operation for Prolapse and Procidentia. In this operation the peritoneum of a portion of the fundus of the uterus is left exposed in the vagina. Compare this with Fig. 309, which shows the Watkins method of vaginal closure. uterus, catching up in its course the corresponding torn edge of the peritoneumon the bladder. This suture is left long and is not tied until arlthe sutures arepassed. Two points are then selected in the base of the bladder on either sideon a transverse line with the first selected point and equally distant. Thesetwo points indicate the cornua of the bladder. Through them similar suturesare passed and carried through the round ligaments or points on the torn-offedges of peritoneum on the surface of either broad ligament sufficiently distantfrom the middle point to take up all the slack in the base of the bladder, from 608 GYNECOLOGY side to side; these sutures are also left long. The three sutures are then tiedsu
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