Operative gynecology : . lator, 6cm. in diameter at the base. If the rigidity can not be overcome in this way,one or two deep lateral incisions through the posterior commissure and extend- OPERATION. 605 ing around one or both sides of the rectum and up into the vaginal sulci, willgive the necessary enlargement. The hemorrhage from the surfaces thus incisedis rarely great enough to call for the use of forceps or ligatures. Continuous irrigation is used to keep the field clear of blood during thefirst part of the operation, until the peritoneum is opened. The vault of the vagina and the cervix
Operative gynecology : . lator, 6cm. in diameter at the base. If the rigidity can not be overcome in this way,one or two deep lateral incisions through the posterior commissure and extend- OPERATION. 605 ing around one or both sides of the rectum and up into the vaginal sulci, willgive the necessary enlargement. The hemorrhage from the surfaces thus incisedis rarely great enough to call for the use of forceps or ligatures. Continuous irrigation is used to keep the field clear of blood during thefirst part of the operation, until the peritoneum is opened. The vault of the vagina and the cervix being exposed as described, theanterior lip of the cervix is caught by tenaculum forceps and drawn down;the posterior lip is also caught, and a stout needle is passed through the anteriorand posterior lips, carrying a heavy silk suture about 40 cm. (16 inches) or four of these ligatures are passed, and each one tied tightly, drawingthe lips firmly together and completely closing the cervical canal and covering. Fig. 343.—Vaginal the operation by cutting the cervix loose from the vaginal vault, under continuousirrigation. in the diseased area, to prevent the escape of any of the intra-uterine contentsover the wound area during the enucleation. The ligatures are left long toserve as tractors, and enable the operator to hold the uterus down near the out-let, and to keep pulling it farther and farther down, delivering it graduallyas its attachments are severed (see Fig. 342). The cervix is first drawn down toward the vaginal outlet as far as it will 606 VAGINAL HYSTERECTOMY. come, often outside, and an assistant on either side holds back the lateral vaginalwalls with a retractor so as to prevent them from hiding the field of operator, pulling on the traction ligatures, now makes a circular incisionaround the cervix and through the entire thickness of the vaginal vault, not lessthan 2 cm. (f inch) distant from the margin of the disea
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectgynecology, bookyear1
