File:Gynecology - (1918) (14586948659).jpg

Identifier: gynecologygrav (find matches)
Title: Gynecology :
Year: 1918 (1910s)
Authors: Graves, William Phillips, 1870-1933
Subjects: Gynecology Genital Diseases, Female Women Gynecology
Publisher: Philadelphia : Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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l wall (Fig. 358). Whenthe level of the urethra is reached the scissors are opened and withdrawn, thuscreating an area of separation of bladder and vagina, the amount of whichvaries according to the size of the cystocele and the amount of adherence be-tween the two layers of tissue. In performing this part of the operation thereis considerable danger of injuring the bladder. This must be guarded against OPERATIONS FOR UTERINE MALPOSITION 703 by gentle manipulation of the tissues. When the bladder and vagina have beenseparated, the anterior vaginal wall is incised along the median line and theedges of the flaps caught with pressure forceps. The flaps are then strippedfurther back by blunt dissection.. The amount of stripping of these flaps shouldbe only enough to cover the anterior wall of the uterus in its new position. Incase of an extensive cystocele, where it is desirable later to cut away redundantparts of the wall, the stripping of the flaps is, of course, carried further. \\mbus
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~Ni^£xweS- Fig. 361.—Watkins Operation for Procidentia.The crown suture. The next step is to separate the bladder from the cervix. This is done byinserting the scissors in the line of cleavage for a short distance and then openingthem (Fig. 359). This process is repeated carefully, and with the points of thescissors pressing against the cervix until the movable plica of the peritonealreflection from bladder to uterus is reached. The separation of the bladder isnot always easy. In cases of difficulty Watkins recommends separating the 704 GYNECOLOGY lateral portions first, as the adherence of the tissues is less there than along themedian line. Where the peritoneal fold comes into view it is picked up with tissue forcepsand cut. The opening thus made is enlarged either by cutting or by forcingit open with the finger. The next step is the delivery of the uterus through the wound. A narrowretractor is inserted, drawing the bladder well up to the symphysis. The ante-rior wall of the ute

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