Gynaecology for students and practitioners . Fig. 461. Myomectomy by Morcellement. The tumour is removedpiecemeal by seizing and cutting away segments of growth within its capsule. of each wall. The uppermost stitch is placed just above the upperangle of the incision. The last suture should be so placed as to effectaccurate apposition of the lips of the external os. The integrity of thecervix having been restored the bladder retractor is removed, andthe crescentic or flap incision in the vaginal mucous membrane isthen closed by interrupted catgut stitches {see Fig. 462), A drain ofbismuth gauz
Gynaecology for students and practitioners . Fig. 461. Myomectomy by Morcellement. The tumour is removedpiecemeal by seizing and cutting away segments of growth within its capsule. of each wall. The uppermost stitch is placed just above the upperangle of the incision. The last suture should be so placed as to effectaccurate apposition of the lips of the external os. The integrity of thecervix having been restored the bladder retractor is removed, andthe crescentic or flap incision in the vaginal mucous membrane isthen closed by interrupted catgut stitches {see Fig. 462), A drain ofbismuth gauze is inserted into the uterine cavity. DILATATION OF THE CERVIX AND CURETTING 793 DILATATION OF THE CERVIX AND CURETTING Dilatation of the Cervix. Apart from pregnancy, this operation may-be performed in the following conditions : (1) spasmodic dysmenor-rhoea ; (2) as a preliminary to curetting or other intra-uterine opera-tions ; (3) to establish drainage in pyometra or purulent Fig. 462. Vagestal Myomectomy, showing the final stage of the operation. The vulva and vagina having been thoroughly swabbed anddouched under the anaesthetic, a careful bimanual examination of thepelvic organs should be made, as a routine procedure, before anythingelse is done. The most convenient speculum to use for depressing theperineum is that of Auvard {see Fig. 463), which is self-retaining. Thebest lateral retractor is that of Jayle, which is also self-retaining {seeFig. 414, p. 736). The cervix is then seized with a volsella and itscondition noted. Next, the sound is passed to observe the length andcapacity of the uterine cavity and the condition of its waUs. A firm
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
