. Operative gynecology. ttachments whichstill hold it in the pehds. These investing tissues are, as a rule, not vascular,and ligatures may be generally dispensed with. The top of the broad ligamentis then closed in by a continuous catgut suture (see Figs. 443 and 444). When the entire mass lies beneath the peritoneum the enucleation is moredifficult and the difficulties increase in direct ratio with the size of the tumor. On opening the abdomen in the case of a large retroperitoneal tumor, theposterior and the visceral layers of the peritoneum may be found lying in directcontact with the anter
. Operative gynecology. ttachments whichstill hold it in the pehds. These investing tissues are, as a rule, not vascular,and ligatures may be generally dispensed with. The top of the broad ligamentis then closed in by a continuous catgut suture (see Figs. 443 and 444). When the entire mass lies beneath the peritoneum the enucleation is moredifficult and the difficulties increase in direct ratio with the size of the tumor. On opening the abdomen in the case of a large retroperitoneal tumor, theposterior and the visceral layers of the peritoneum may be found lying in directcontact with the anterior wall, the pelvic peritoneum is lifted up, the rectum isdisplaced, and the sigmoid or the colon pushed forward. The ureter is usuallybehind the growth, and if injured, the injury comes from detaching it from anadherent tumor. The uterus is displaced by an intraligamentary tumor toward the oppositeside, or if there are intraligamentary tumors on both sides, it is crowded betweenthem into the front part of the j^ 24, 1894. If both sides are affected, it will be easier and better to operate by removingthe uterus and tumors together, by ligating the ovarian vessels first on one side,and so opening up the broad ligament and peeling out and rolling one of the 302 OTAEIOTOMT. tumors with the uterus up and out of the incision, and controlling the uterinevessels of that side. The uterus is then amputated in its cervical portion, the
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectgenitaldiseasesfemal
