File:Gynecology (1916) (14593121340).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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Fig. 275.—Anterior Colpotomy for Pelvic Operations by the Vaginal Route. comparatively little used, and is for the most part confined to operations forprolapse, like those of Watkins and Goffe, and occasionally to vaginal hysterec-tomies. 576 GYNECOLOGY The pelvis may be entered either by opening the anterior or posterior wallof the vagina. Anterior colpotomy is performed in the following way: The anterior lip ofthe cervix is seized with traction forceps, and the uterus drawn strongly downtoward the introitus. The peritoneal cavity may be entered either through atransverse incision made at the junction of the bladder and cervix or, pre-ferably, by a 1-shaped opening. By the latter method an incision is madefrom a short distance below the urethra to the cervix. The vaginal wall oneach side is then loosened from the bladder and a cross incision made at right
Text Appearing After Image:
Fig. 276.—Posterior Colpotomy.Crucial incision through the posterior vaginal wall into the culdesac of Douglas. angles to the first, at the level of the junction of the bladder with the cervix.The two flaps are further separated from the bladder wall by blunt dissectionand drawn outward by traction hooks. The bladder is then stripped backfrom the cervix, care being taken not to injure its wall. When the peritonealreflection is reached it is seized with tissue forceps and incised, the incisionbeing carried to each side into the broad ligaments as far as possible. Theperitoneum of the bladder reflection is lifted up and cut in the median lineas far as the fundus of the bladder (Fig. 275). Into the opening thus made isinserted a speculum which draws the bladder up to the symphysis. The nextstep is the delivery of the uterus and adnexa through this opening. The traction OPERATIONS ON THE VAGINA 577 forceps on the anterior cervical lip is forced back toward the posterior wall ofthe vagin

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