(2) To contract the musculature of the uterine wall, a suitable drug may be
injected into the fundus. If the tumor is riding over the bladder or to free the ligament
from the tumor, the round ligament may be doubly clamped, cut, and ligated, as in
hysterectomy. The broad ligament may be opened to determine the course of the
ureter or to free the bladder by means of curved hemostats and Metzenbaum scissors.
(3) An incision is made in the uterine wall down to the fibroid tumor which is
grasped with a tenaculum.
(4) Each tumor is shelled out of its bed, using blunt and sharp instruments.
Bleeding vessels are controlled by deep interrupted sutures number 2-0 chromic gut.
(5) The uterus is reconstructed with interrupted chromic gut number 2-0
sutures swaged to 3/8- circle trocar-point needles held on long needle holders.
(6) The round ligament is reapproximated by several interrupted sutures,
and the anterior sheath of the broad ligament is closed. The perimetrium is closed over
the operative site. The abdominal wound is closed.
2-39. UTERINE SUSPENSION
a. General. The operation involves the shortening of ligaments by suturing to
muscle structures through an abdominal incision. Uterine suspension is rarely done
today, except as part of the conservative surgical treatment of some types of pelvic
inflammatory disease or endometriosis when the uterus is bound down on the
b. Operative Procedure.
(1) The abdomen is opened, as for myomectomy as stated in
(2) As part of salpingectomy, a modified Coffey suspension may be done to
hold the uterus forward and suspend the ovaries so that they cannot prolapse into the
cul-de-sac. The round ligaments are sewn toward the bladder. The wound is closed in
layers as for laparotomy.
2-40. OOPHORECTOMY AND OOPHOROCYSTECTOMY
a. General. Oophorectomy is the removal of an ovary. Oophorocystectomy is
the removal of an ovarian cyst. A wide variety of tumors, both benign and malignant,
are found in ovaries. Functional cysts comprise the majority of the ovarian
enlargements, follicle cysts being the most common. The choice of operation depends
on the patient's age and symptoms, findings on physical examination, and direct
examination of the adnexa during exploration. If the ovarian tumor is recognized as
benign, only the visibly diseased portions of the adnexa are removed. In the presence