Fig. 213.—Supra-vaginal amputation of the uterus, first step: ligatures have been placed on the ovarian arteries and the round ligament.
The infundibulo-pelvic ligament immediately outside of the abdominal ostium of the tube, the round ligament between the ligature and the cornu, and the broad ligament as far as the uterus should then be divided with scissors on each side.
The uterus is thus freed from all its attachments down to a point somewhat above the level of the internal os. The vessels that remain to be secured are the uterine arteries.
The peritoneum is next divided by a transverse incision across the anterior face of the uterus, immediately below the line of reflection of the peritoneum from the uterus to the bladder. This incision should join at each end the incisions that had been previously made in dividing the broad ligaments.
Fig. 214.—Supra-vaginal amputation of the uterus, second step: the broad ligaments have been divided down to the level of the internal os uteri.
The bladder should then be dissected from the anterior face of the uterus and cervix, down to the vaginal junction.
The bladder is but loosely attached to the uterus, and may be readily pushed off with the finger or with closed scissors. The finger pressed out to a short distance on each side of the cervix will push away the anterior layer of the broad ligament with the bladder, so that the uterus is perfectly free in front.
Fig. 215.—Supra-vaginal amputation of the uterus, third step: the peritoneum has been incised across the anterior face of the uterus; the bladder has been dissected from the cervix; the bases of the broad ligaments have been opened; the uterine arteries have been secured by ligatures placed between the ureters and the cervix.