Gynaecology for students and practitioners . nalis below the level of the reflectionof the bladder. Two additional antero-lateral incisions may bemade as shown in Figure 449, in order to provide more bladder is next dissected off the cervix {see Fig. 450). Whenthis is done the cervix is drawn to one side, and the ligation and divisionof the parametric tissues are commenced. These include the sacro-uterine ligament behind, and the vesico-uterine parametric tissue infront, and they make up together a wide attachment of cellular tissueto the sides of the cervix. It is therefore advisable
Gynaecology for students and practitioners . nalis below the level of the reflectionof the bladder. Two additional antero-lateral incisions may bemade as shown in Figure 449, in order to provide more bladder is next dissected off the cervix {see Fig. 450). Whenthis is done the cervix is drawn to one side, and the ligation and divisionof the parametric tissues are commenced. These include the sacro-uterine ligament behind, and the vesico-uterine parametric tissue infront, and they make up together a wide attachment of cellular tissueto the sides of the cervix. It is therefore advisable to ligate themseparately. The cervix should be drawn forwards during the tying ofthe sacro-uterine ligament, and backwards whilst ligating the vesico-uterine parametric tissue. In Figure 452 this has been done on the VAGINAL HYSTERECTOMY 783 right side and the ligatures are shown drawn aside. To avoid injuryto the ureters, continuous retraction of the bladder is kept up bymeans of a spatula inserted between the cervix and that viscus (.see. Fig. 452. Vaginal Hysterectomy. On the right side the sacro-uterineligament and the vesico-uterine parametric tissue have been divided. Fig. 457, p. 788) ; the ureters are drawn up in this way, togetherwith the bladder, whilst the needle carrying the ligature is passed asclose to the cervix as possible. ^HANRURY^.. Scale s Full Size [ho .
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
