Fig. 219.—Vaginal hysterectomy with clamps: first step (Baldy).
The following are the general directions for the performance of the operation:
The woman is placed in the lithotomy position. The vagina is opened with the Sims speculum and with lateral vaginal retractors ([Fig. 218]).
If the cervix is septic, it is thoroughly curetted, sterilized with the cautery or by other means, and the sides of the excavation are united by suture.
The cervix is seized by tenaculum forceps and dragged downward and forward.
A transverse incision with knife, scissors, or cautery is made in the posterior vaginal fornix, and Douglas’s pouch is opened.
Fig. 220.—Vaginal hysterectomy with clamps: second step (Baldy).
A sponge is introduced into the peritoneum behind the uterus.
Some operators suture the posterior peritoneal layer of Douglas’s pouch to the posterior vaginal wall, to control bleeding and to prevent stripping of the peritoneum.