Essentials of gynecology : arranged in the form of questions and answers prepared especially for students of medicine.

Cragin, Edwin B.

Date:: 1913

Credit: Essentials of gynecology : arranged in the form of questions and answers prepared especially for students of medicine. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$is drawn down and separated from its vaginal attachments; the peritoneum is opened anteriorly and posteriorly and the uterine aiteries are tied on both sides. If the uterus is too large to be removed as a whole, wedge- or dise-sha])ed pieces are removed from its centre or the uterus is divided in the median line and each half removed separately, care being taken to keep up traction on the uterus by volsellge placed above the part to be removed. The broad hgaments are either ligated in section, or if more convenient during the operation, they may be clamped, and after the uterus is removed these clamps may or may not be replaced by Hgatures according to the judgment of the operator. After the removal of the uterus, the pedicles are inverted into the vagina and sterile or iodoform gauze placed against them. Describe the operation of abdominal hysterectomy for fibro- myoma uteri. The preceding operation, owing to the amount of technical skill required and the difficulty in safely handling intestinal adhesions, has largely tallen into disrepute and given place to one of the two following forms of abdominal hysterectomy : a. In one the cervix is removed—total extii'pation. With this are associated the names Eastman, ]\Iartin, Chorbak, Polk. h. In the other the cervix is left in the abdominal cavity— supravaginal h.vsterectomy. This is called Baer's method. In both of these methods, after opening the abdomen, the broad ligaments are tied in section and cut close to the uterus. In the total extirpation this ligation and cutting is continued down to the vagina : this is freed fi'om the cervix and the whole uterus removed. In the supravaginal hysterectomy (Baer) the hgation and cut- ting of the broad hgaments is continued until the cervix is reached and the uterine arteries are tied and cut; the uterus is then ampu- tated at the cervix, and the latter is left, the vagina not being opened. In each of these methods flaps of peritoneum are taken from the anterior and posterior sm'faces of the uterus before its removal, and before closing the abdomen these flaps are brought together over the pedicles in the bottom of the pelvis.$