Gynecology . Fig. 337.—Vaginal the uterovesical space (after Doderlein-Kronig). some bleeding from the vaginal vessels, which should be controlled as theuterus is removed. The round ligaments are then sewed into the corners of thevaginal wound. This is an important step, for it prevents to some extent alater prolapse of the vaginal wall. The anterior and posterior vaginal walls areapproximated by interrupted catgut sutures. HYSTERECTOMY OPERATIONS 631 WERTHEIMS EXTENDED OPERATION FOR CANCER OF THE UTERUS The Wertheim operation is used both for cancer of the cervix and canc
Gynecology . Fig. 337.—Vaginal the uterovesical space (after Doderlein-Kronig). some bleeding from the vaginal vessels, which should be controlled as theuterus is removed. The round ligaments are then sewed into the corners of thevaginal wound. This is an important step, for it prevents to some extent alater prolapse of the vaginal wall. The anterior and posterior vaginal walls areapproximated by interrupted catgut sutures. HYSTERECTOMY OPERATIONS 631 WERTHEIMS EXTENDED OPERATION FOR CANCER OF THE UTERUS The Wertheim operation is used both for cancer of the cervix and cancer ofthe body of the uterus. Its chief object is to remove with the uterus as muchof the parametrial tissue as possible and to include a wide margin of the vagina. The description of the operation given below applies to cancer of the cancer of the body the same technic may be applied, but the dissection ofthe parametrium and the vaginal margin need not be so \ Fig. 338.—Vaginal off the adnexa. Before operating on a case of cancer of the cervix, especially of the evertingtype, it is usually necessary to remove the necrotic excrescent growth from thevagina. By the original Wertheim method this is done without anesthesiaimmediately before the performance of the radical operation. Some curetthe cervix just before, with the patient under anesthesia. It is our custom todo the preliminary cureting under light narcosis about a week or ten days beforeattempting the main operation. In performing the preliminary operation the chief object is to removemerely the main bulk of the cancerous mass in order to facilitate the later opera-tion, and to leave the cancerous field so that it can be made as clean as possible 632 GYNECOLOGY
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