The diseases of women : a handbook for students and practitioners . oyedfor amputation of the cervix. The Steps of the Operation.—The patient, duly anaesthe-tized, is fixed in the lithotomy position facing a surgeon, seated at a convenient level, introduces thebill of a large speculum into the vagina. The cervix isthen seized with a stout volsella and drawn down. Theassistant by means of a sound in the bladder keeps theoperator informed as to the precise relation of that viscus tothe cervix. The mucous membrane on the anterior aspect of thecervix is then transversely divided with a
The diseases of women : a handbook for students and practitioners . oyedfor amputation of the cervix. The Steps of the Operation.—The patient, duly anaesthe-tized, is fixed in the lithotomy position facing a surgeon, seated at a convenient level, introduces thebill of a large speculum into the vagina. The cervix isthen seized with a stout volsella and drawn down. Theassistant by means of a sound in the bladder keeps theoperator informed as to the precise relation of that viscus tothe cervix. The mucous membrane on the anterior aspect of thecervix is then transversely divided with a scalpel, takingcare not to injure the bladder. The operator then separates 374 DISEASES OF WOMEN. the bladder from the cervix by means of the handle of thescalpel (Fig. 108). The incision is next prolonged around the cervix, and bymeans of scissors an opening is made into the recto-vaginalfossa through the posterior cul-de-sac of the vagina; asponge is then inserted to restrain as well as protect theintestines. The operator now deals with the broad ligaments. A. Fig. 108.—First stage of vaginal hysterectomy: it shows the bladder reflected from thecervix and the position of the uterine arteries. pedicle-needle (or a curved needle) armed with stout silk ismade to transfix the tissues at the side of the uterus, keep-ing quite close to the cervix in order to avoid the ligature is firmly tied, and will include the uterineartery as it passes from the mesometrium to the side of theuterus (Fig. 108); the tissue between it and the cervix is OPERATIONS ON THE UTERUS. 375 divided with scissors, care being taken to leave sufficienttissue to prevent the ligature from slipping. The samemanoeuvre is carried out on the opposite side. The effectof this is to free the uterus considerably, and to enable it tobe well drawn down by the volsella. A double ligature isnow carried through the remaining section of the mesome-trium and the two halves are tied: the upper ligature encir-cle
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