A Text-book of Diseases of Women

by Charles B. Penrose

The posterior layer of the broad ligament and the cellular tissue may then be divided, with scissors, along the side of the uterus down to a point somewhat below the level of the internal os. This incision should not be made too close to the uterus, or the uterine artery that runs up along side of the uterus and cervix may be divided. The operator should place one or two fingers upon the posterior aspect of the broad ligament, immediately beside the cervix, and while the uterus is drawn upward should pass a heavy ligature beneath the tissue that includes the uterine artery. The pulsation of the uterine artery may usually be felt by the finger placed behind the broad ligament. This ligature includes the cellular tissue at the base of the broad ligament, the uterine artery, and part of the posterior peritoneal layer of the broad ligament. It does not pass through the anterior peritoneal layer of the broad ligament, which had been previously dissected away. The ligature should be placed as closely as possible to the cervix without including cervical tissue. It should be remembered that the ureter lies about half an inch from the side of the normal cervix and at the level of the external os. The ureter is usually more remote than this when the ligature is passed, because the uterus is drawn upward and the ureter is pushed aside by the fingers at the side of the cervix.

The uterine artery should be secured in a similar way upon the opposite side.

The bases of the broad ligaments should then be divided with scissors between the cervix and the ligatures of the uterine arteries. To prevent slipping of the ligature, ample tissue should be left between the incision and the ligature. As the cervix is not malignant, the incision may be made as close to this structure as necessary.

Fig. 216.—Supra-vaginal amputation of the uterus, fourth step: the uterus has been amputated below the level of the internal os; sutures have been introduced to close the stump of the cervix.

The uterus should then be amputated by a wedge-shaped incision through the cervix, making an anterior and a posterior flap.

When the cervical canal is opened, it may be immediately sterilized with a solution of bichloride of mercury (1:500).

As the uterus is cut away the flaps of the cervix are secured with forceps. The cervical stump is usually white and dry.

The flaps of the cervix should next be united by interrupted silk suture. Care should be taken to avoid passing a suture through the cervical canal, as it might become infected.