File:Gynecology (1916) (14780012995).jpg

Identifier: gynecologygrav2 (find matches)
Title: Gynecology
Year: 1916 (1910s)
Authors: Graves, William Phillips, 1870-1933
Subjects: Gynecology Genital Diseases, Female Women Gynecology
Publisher: Philadelphia and London : Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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on has been made exposing the vaginal portion of the cervix.The vagina is divided in a circular direction, starting from the small incision. The operation of coning the cervical mucosa is performed in the follow-ing way: All the preliminary steps of a supravaginal amputation are carriedout as described above. Then, instead of amputating the uterine body in theusual way, it is dissected away by a deep circular incision in the tissues of thecervix extending to the portio, so that most of the cervix is removed with the HYSTERECTOMY OPERATIONS 627 uterus in the form of a cone-shaped wedge, including all of the cervical mucousmembrane. By this method very little bleeding is encountered and there isabsolutely no danger of injuring the ureters. As only a minimum of vaginalsurface is exposed, the wound in the cervix may usually be closed as in anordinary supravaginal hysterectomy without drainage, provided, of course,there has been proper preliminary preparation of the vagina. If it seems de-
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Fig. 335.—Complete Hysterectomy. The cervix has been grasped by the anterior wall and delivered through the opening in the vagina. The posterior wall of the vagina is about to be severed with scissors. sirable to drain, it may be done as in the operation for complete hysterectomydescribed below. Complete hysterectomy is indicated in certain cases of myoma involving thecervix, or when a severe laceration of the cervix is present, or when the grossappearance of the fundus suggests the presence of adenocarcinoma. Somecases of malignant disease of the ovaries or of extensively adherent intra-ligamentary cysts require complete hysterectomy. 628 GYNECOLOGY The Steps of the Operation.—The adnexa and uterine vessels are securedand ligated as in the operation of supravaginal hysterectomy. The utero-vesical plica of peritoneum is divided, and the bladder stripped away from thecervix and upper vagina by blunt scissors dissection. The parametria! tissueis then clamped very close to the cervix

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