(9) The bladder is retracted with a laparotomy pack and a retractor with an
angular blade. The vaginal vault is incised with a knife close to the cervix.
(10) The anterior lip of the cervix is grasped with an Allis or tenaculum
forceps. With Metzenbaum scissors, the cervix is dissected and amputated from the
vagina. As the vagina is opened, the anterior and posterior walls are approximated with
Allis or Teale forceps. The uterus is removed. Potentially contaminated instruments
used on the cervix and vagina are placed in a discard basin and removed from the field
(including sponge forceps and suction). Bleeding is controlled with hemostats and
(11) The vaginal vault is reconstructed with chromic interrupted sutures.
Angle sutures anchor all three connective tissue ligaments to the vaginal vault.
(12) Vaginal mucosa is approximated with a continuous chromic gut suture
swaged to a 3/8-circle needle on a long needle holder. The muscular coat of the vagina
is closed with figure-of-eight sutures to make the vault of the vagina firm and provide
(13) The peritoneum is closed over the bladder, vaginal vault, and rectum.
The laparotomy packs are removed, and the omentum is drawn over the bowel.
(14) The abdominal wound is closed in the regular way.
2-37. SUBTOTAL (SUPRACERVICAL) HYSTERECTOMY
Through an abdominal incision, the peritoneal cavity is opened and the body of
the uterus is removed, leaving the cervix in place. This subtotal hysterectomy is seldom
done in modern gynecology, except in emergencies to terminate a procedure because
of shock or cardiac arrest or in abdominal carcinomatosis in conjunction with the
removal of the primary tumor in the ovary.
2-38. ABDOMINAL MYOMECTOMY
a. General. This operation involves the removal of fibromyomas from the
uterine wall through an abdominal incision. It is usually done in young women with
symptoms that indicate the presence of tumors and who have had no children. The
tumors may be removed because of infertility or habitual abortion or because of
distortion of the bladder and other organs. Myomectomy may be performed in
conjunction with other abdominal pelvic surgery as a prophylactic measure.
b. Operative Procedure.
(1) The patient is prepared as for abdominal hysterectomy. A midline or
Pfannenstiel incision is used and the uterus exposed.