(v) A preliminary to the performance of vaginal hysteropexy.
(vi) Those cases in which the patient’s general condition is unfavourable to the performance of exploration by the abdominal route.
Anterior colpotomy is more suitable for removing small tumours growing from the anterior wall of the uterus, or for conservative operations on the ovaries. Posterior colpotomy is more suitable for removing inflamed appendages, and for evacuating collections of pus or blood from Douglas’s pouch.
Fig. 47. Pozzi’s Retractors.
Posterior colpotomy has been used for many years for the opening of abscesses and hæmatoceles in Douglas’s pouch. The anterior operation is of more recent date, and its relative advantages and disadvantages and the indications for its use have not yet been definitely agreed upon by the majority of gynæcologists. Taking all things into consideration, the disadvantages of colpotomy seem to outweigh its advantages, and, except for the evacuation or drainage of collections of blood or pus behind the uterus, the operation may be said to have few indications.
The patient is in the lithotomy position, the speculum is passed and the cervix pulled down by a tenaculum. The T-shaped incision has been made.
b. Outline of bladder.
c. Cervix.
cl. Clitoris.
l.m. Labium minus.
sp. Speculum.
u. Urethral orifice.
v,v',v''. Volsella.