Gynaecology for students and practitioners . Fig. 423. Total Abdominal Hysterectomy. On the left side the infundi- bulo-pelvic fold has been divided. The utero-sacral fold is clamped ready for division. 1 = Forceps on round ligament. 2 = Forceps on infundibulo- pelvlc fold. 3 = Forceps on utero-sacral fold. 748 GYNECOLOGY the lateral wall of the isthmus (supra-vaginal cervix). Tractionby means of the volsella puts the parametrium on the stretch,and as the uterine vessels and ureter have already been displaced,the parametric tissues may be clamped by forceps. The firstpair of forceps grasps the
Gynaecology for students and practitioners . Fig. 423. Total Abdominal Hysterectomy. On the left side the infundi- bulo-pelvic fold has been divided. The utero-sacral fold is clamped ready for division. 1 = Forceps on round ligament. 2 = Forceps on infundibulo- pelvlc fold. 3 = Forceps on utero-sacral fold. 748 GYNECOLOGY the lateral wall of the isthmus (supra-vaginal cervix). Tractionby means of the volsella puts the parametrium on the stretch,and as the uterine vessels and ureter have already been displaced,the parametric tissues may be clamped by forceps. The firstpair of forceps grasps the utero-sacral ligament which is dividedon the uterine side of the clamp {see Fig. 423 [3]) The secondpair is applied to the utero-sacral ligament on the opposite side, whichis then likewise severed. The scissors are then inserted on the flatunder the peritoneum at the back of the uterus and pushed across from. Fig. 424. Total Abdominal Hysterectomy. The infundibulo-pelvic and the utero-sacral ligaments are ligatured on both sides ; the clamps are removed. The peritoneum is being sej^arated from the posterior uterine wall. right to left, from one cut utero-sacral ligament to the other {see dottedline in Figs. 423 and 424). The peritoneum thus freed is then di^ided,and the rectum, which is thereby exposed, is pushed down by breakingthrough its loose attachment to the vagina. A third and fourth clampare now used to grasp the lateral parametric tissues on either side of thecervix. This lateral parametric tissue is then divided by keeping thescalpel close to and by cutting on the cervix. The deep lateral dissec-tion is carried down on either side, until the vagina is reached ; a pointwhich is easy to notice, because the vaginal walls are laxer and lessresistant than the cervix. As to where the vagina is to be opened isa matter of choice ; some operators open it in front, others at the l
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
