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The effect of sectioning the broad ligament ipsilateral to the corpus luteum on estrous cycle length was evaluated. This surgical procedure ioIated the region of proposed transfer of the uterine luteolytic factor from uterine venous input. The estrous cycles of four of five animals were prolonged to at least 30 days, as judged by plasma progesterone concen- trations and the presence of marked corpora lutea at laparotomy on Day 30. In a second experiment, one of the branches of the ovarian artery was cannulated in the hilus of the ovary in five dairy cows, and 6 mg of prostaglandin Fr,, (PGF�.) was injected into thc lumen of the uterine horn ipsilateral to the cannula on Days 12 or 13 of the cycle. Frequent samples were collected simultaneously from the ovarian artery, carotid artery, and jugular vein. The concentration of prostaglandins of the F series (PCF) was observed to increase rapidly at all three sampling sites following administration of PCF,,,. While the concentra- tion was highest in the carotid and jugular within 5 mm of treatment, the concentration of PGF continued to increase in the ovarian artery to reach a peak 40 mm after treatment and remained at levels significantly greater (p

Distribution of the blood supply to the reproductive structures of the nonpregnant estrous rabbit doe was studied utilizing silastic plastic injection casts of the vessels in conjunction with selective ligation and measurements of blood flow by hydrogen gas desaturation. The vascular casts demonstrated patent anastomosing channels between the uterine and ovarian arteries as well as anastomoses within the oviductal supply between vessels arising from the ovarian and oviductal branches of the ovarian artery. Uterine blood flow equaled 0.588 ml/min/g in 18 does while oviduct blood flow equaled 0.584 in 17 females. The functional significance of the anastomoses was tested by ligating either the ovarian or internal iliac artery and measuring blood flow to the oviduct and to the uterus before and after ligation. After ovarian artery ligation, blood flow to the oviduct ceased while internal iliac ligation resulted in cessation of flow to the uterus. These data suggest that distinct functional regions of supply exist in each of the two arterial blood sources.

In the ovarian vein blood of normal female dogs treated with large doses of human chorionic gonadotropin for 10 consecutive days, progesterone, Δ 4 -androstene-3,17-dione and 17α-hydroxyprogesterone were isolated and identified. The amount of human chorionic gonadotropin given to the animals before ovarian cannulation could not have been maximal since the acute administration of human chorionic goadotropin, follicle-stimulating hormone containing luteinizing hormone, and luteinizing hormone resulted in an augmentation of ovarian vein-blood progesterone and Δ 4 -androstene-3,17-dione. We have, however, been unable to show consistently that [1- 14 C]acetate administered by the ovarian artery will be incorporated into 14 C-containing steroids of the ovarian vein blood.

The recent generalization that one-third of the important decisions in the cases of sick patients are based on radiologic judgments (10) does not include gynecology. The gynecologist requests proportionately fewer radiologic consultations. This is in part because his work allows direct examination, and in part because standard x-ray examinations are generally not informative in problem cases. However, the “clinical examination of pelvic viscera is occasionally inadequate and often inaccurate, even when performed by experienced physicians. In a review of 300 consecutive pelvic laparotomies, it was found that nearly half of the time the preoperative pelvic examination was incorrect or incomplete” (11). Partial answers to this problem have been provided by hysterosalpingography and pelvic pneumography. But according to Lang (7) “the single most important advance toward an accurate preoperative diagnosis of pelvic tumors can be attributed to pelvic angiography.” Unfortunately, a high proportion of such studie...

Ligation of the uterine vasculature was performed on the 10th or 18th day of gestation in 114 Wistar rats. In each rat the blood vessels of one uterine horn were ligated at the level of the oviduct, midhorn, or the cervix; the opposite horn served as a control. Fetal weight and mortality data were analysed for the effect of the vascular interruption and the effect of intrauterine position. It was found that patency of the ovarian artery was not essential for normal fetal growth and that the loop-artery configuration of the vessels to the uterine horn was not a determinant of the position effect. The time in gestation at which the ligation was performed had a decided effect on ultimate fetal weight: the later in gestation, the greater the fetal growth retardation. Various factors that could be responsible for the position effect are discussed. It is suggested that the association between fetal weight and intrauterine position is species dependent and is determined by unknown factors, not singly by hemodynamics, myometrial pressure, or time of implantation.

In the cow ewe and sow LH plays an important luteotropic role although supporting evidence in the sow is less conclusive than for the cow and ewe. Prolactin does not seem to play an important luteotropic role in either the cow ewe or sow. There is little evidence to indicate the role of FSH in the large animals. Exogenous estrogens are luteolytic in the cow and ewe but luteotropic in the sow. In all 3 species lysosomal activity appears to initiate luteolysis. Administration of exogenous estrogen in the cow and ewe causes luteal regression. Exogenous progesterone early in the cycle decreases the length of the cycle in the cow and ewe but not in the sow. The uterus produces at least 1 substance which can cause regression of the corpus luteum in all 3 species. In the cow and ewe prostaglandin F-2-alpha in the uterine vein is thought to be responsible. In vitro studies do not fully substantiate the assumed role of prostaglandins. Anatomical relationships between the uterine vein and ovarian artery in species in which the uterus plays a luteolytic role suggest a possible but still unsubstantiated transfer process between the uterine vein and ovarian artery.

A spiral artery within the hilus of the ovary is demonstrated. It is formed by a helix-type of formation from the ovarian artery as it enters the hilus of the ovary and turns sharply cephalad. Further vascularization of the ovary is accomplished by secondary branches arising from the coils of the spiral artery. The speculative implications of this arrangement of the ovarian circulation are discussed in relation to (a) cyclic or periodic ovarian growth; (b) hemodynamic conditions within the uterus; and (c) to the etiology of ovarian pathology.

In order to determine if the ovarian metabolism of pregnenolone differed between estrus and pregnancy, [7α-3H]pregnenolone was infused by the ovarian artery in anesthetized dogs and steroids containing tritium isolated in ovarian vein blood. 1. 1. Within 5 min the canine ovary metabolized pregnenolone to 17α-hydroxy-pregnenolone, progesterone, 17α-hydroxyprogesterone, dehydroepiandrosterone, androsterone, testosterone and probably estradiol. 2. 2. Induction of mating in the female dog by treatment with human chorionic gonadotropin was associated with a high capacity of the ovary to convert pregnenolone to testosterone and androstenedione. 3. 3. Dogs in the early part of pregnancy metabolized a considerable amount of the infused pregnenolone to progesterone.

Part. I: Prostaglandin F2Α (PGF2Α) was shown to be ‘the’ luteolysin in the ewe on the following criteria: (1) Hysterectomy and/or separation of the uterine horn from the ovary bearing a corpus luteum led to prolongation of the oestrous cycle, (2) PGF2Α shortened the cycle when administered in the midluteal phase, (3) PGF2Α was identified in uterine venous blood, (4) a mechanism for the transfer of PGF2Α from the uterine vein to the ovarian artery was shown to exist, (5) the quantitative aspects of the secretion transfer mechanism and luteolytic potency of PGF2Α were adequate to account for the observed phenomena. Part II: These criteria were applied for evaluation of PGF2Α as ‘the’ luteolysin in the following species: cattle, goat, horse, pig, guinea pig, rat, hamster, rabbit, monkey, human. On present knowledge, there appeared to be a variation between species from those in which PGF2Α was probably concerned in luteolysis and those in which the evidence was against such a role. Part III: PGF2Α was shown to be luteolytic when given by continuous infusion for 3–6 h into the lumen of the uterus in cattle as well as sheep. The minimum effective dose was of the order of 7 g/kg. The application of this finding to artificial insemination programmes was discussed.

In a female Necturus, anesthetized with urethane, a glomerulus showing sluggish blood flow was observed; the capillary loops were dilated, although not uniformly. The picture was unchanged by pithing the brain. This glomerulus was peculiar in that both afferent and efferent vessels were clearly seen; the afferent vessel came direct from a large ovarian artery. There was no alternation of flow. The afferent vessel was now stroked gently with a fine glass rod; there was no response. More vigorous stroking resulted in a shifting of the kidney region in the field after about a 5 second latent period; this was followed in 5 seconds more by constriction of the afferent vessel to the point of cessation, complete or practically so, of cell movement in the glomerulus. The shifting of the kidney region preceding afferent vessel constriction was seen to be due to a contraction of the ovarian artery from which the afferent vessel sprang, resulting in a tugging on the kidney. It was then found that traction on the ova...

The average blood flow to the ovaries, fallopian tubes, uterine horns and vagina of estrus rabbits was 1.40 ± 0.14, 1.44 ± 0.13, 0.75 ± 0.06, 0.30 ± 0.04 ml/min/g of tissue, respectively. There was no differences between the right and left organs. Ligation of the ovarian artery resulted in 80–90% decrease in blood flow to the ovary and oviduct, but recovery occurred within 1 and 6 days for the ovary and oviduct, respectively. There was no effect on the uterus and vagina. Ovulatory response to HCG occurred within 1 day and pregnancy after 6 days following ligation.

UNTIL RECENTLY, scant attention has been paid to the arrangement of the arteries within the ovary. Older works, such as those of Barkow (1866) and Clark (1900) depict them in the human as a mass of tortuous vessels derived from branches of the ovarian artery as this vessel enters the hilus of the ovary. Later work, based upon gross dissections in the rat, guinea pig, sow, and rabbit (Anders, 1927) do not alter this conception. This work shows schematically the arteries in the hilus of the ovary as forming a network derived from several arteries in the mesovarium. A different description is given by Belou (1934). This investigator examined by stereoscopic X-ray the human female genital tract in which the arteries had been injected with an opaque medium.

Summary. The effect of gonadotrophins on the secretion rate of gonadal hormones in sheep was investigated by perfusing the ovary in situ with luteinizing hormone (lh), luteotrophic hormone (lth) and follicle stimulating hormone (fsh). The gonadotrophins were infused through the side branch of the ovarian artery and the effluent blood was collected from the utero-ovarian vein. Perfusion of the ovary on the 8th day of the oestrous cycle with lh or lth resulted in the increase of the secretion rate of progesterone within 20 to 30 min after the beginning of the perfusion; when the perfusion of the ovary was terminated the rate of progesterone secretion reverted to the original level within 20 to 30 min. Unlike lh and lth, fsh infused on the 8th day of the oestrous cycle decreased the output of progesterone. On the 15th day of oestrous cycle progesterone could not be detected in the effluent blood from the ovarian vein. At that time, perfusion of the ovaries with gonadotrophic hormones produced no effect on the secretion rate of progesterone. Substances giving positive reaction with Barton's reagent and showing chromatographic characteristics of oestrone and oestradiol were detected in the ovarian venous blood in few animals only, and in very low concentrations. No relation was observed between the presence of these substances in the ovarian venous blood and either the phase of oestrous cycle or the type of gonadotrophin infused. Furthermore, perfusion of the ovary with fsh or lh resulted in the appearance in the ovarian venous blood of an unknown oestrogen-like substance of higher polarity than that of oestrone but lower than that of oestradiol.

A study of vascular patterns in the human ovary has been presented. The vascular system in the human ovary is more complex than that of the rabbit. However, it shows helical spiralling with gradual diminishing diameters in the branches of the main ovarian artery. The function of spiralling in the ovarian branches of the arterial system are (1) adaptation of the vasculature to ovarian growth, and (2) to provide a mechanism for the reduction and regulation within the ovary of blood pressure. A relationship exists between arterial spiral distortion resulting from ovarian cysts, corpora lutea, and the arrangement of the ovarian veins. Characteristics of the ovarian artery and its branches have been described. The relation of the condition of the vessels to ovarian activity and inactivity have been discussed. It is suggested that there is a relation between growth and development of ovarian arterial branches and estrogenic activity in the adult. Evidence is presented to show that branching of the arteries in the ovary from late fetal life to shortly after birth is under the influence of maternal hormones. Observation of the venous vascular tree shows completely different characteristics when compared to the arteries.

The purpose of the present paper is to describe a surgical preparation for studying the relationship between the extrinsic and intrinsic innervation of the rabbit's uterus and the myometrial response to oestrin and progestin. This method consists of transplanting the uterus to the anterior abdominal wall, thus severing all the pathways of the motor sympathetic nerves to this organ. It was necessary to perform the operation in 3 stages. After a brief experience it was found desirable to use animals that had dropped at least one litter. Adequate results can often be obtained in animals made pseudopregnant.First stage. A mature female rabbit weighing approximately 3 1/2 kg. was anesthetized with ether. A longitudinal incision was made to the right of the midline, starting about 3 cm. above the symphysis and extending cephalad a distance of about 6 to 8 cm. The right uterine cornu was brought up into the wound, the tubal end clamped, ligated and incised. Included in this ligature was the ovarian artery and wh...

This article describes an investigation to influence corpus luteum function in hysterectomized sheep using extracts of uterine origin. Freeze-dried uterine venous plasma withdrawn at different times during the estrous cycle of sheep was infused into the ovarian artery of intact sheep on Day 8 of normal 16 day cycle and study of the effects of infusion on corpus luteum function and length of the resultant estrous cycle was conducted. Results on 7 sheep are reported. Methylene blue was periodically injected into fluid to attest that the infusion was entering ovary. At start and termination of infusion blood was collected from ovarian veins and progesterone was measured on u.v. spectrophotometer. Ovarian venous plasma progesterone levels fell by about 50% during 6 - 8 hr. infusion of freeze-dried plasma to sheep on the eigth day of cycle. The sheep returned to estrous between 48 and 72 hr. after cessation of infusion on Day 10 or Day 11 of the cycle. A rapid drop in progesterone level during infusion and shortening of cycle length are both significant indices of early corpus luteum regression.

Treatment with PMSG is still the most widely used method of inducing superovulation in cattle. A major problem, however, is the great variation in response of individual animals to identical treatments (Foote & Onuma, 1970; Mariana, Maul\l=e'\on,Beno\l=i^\t& Chupin, 1970). This variation may, in part, be due to differences in the absorption of injected PMSG and its subsequent distribution to the ovary. In rabbits, intraovarian rather than systemic injection is said to be a more sensitive test for PMSG in the Friedman pregnancy test (Chicchini & Chiacchiarini, 1963) and intrafollicular injection of LH also induces ovulation (Jones & Nalbandov, 1972). This report describes an investigation of the possibility that local injection of PMSG into bovine ovaries might produce more consistent superovulatory responses than do systemic injections. As outlined in Table 1, thirteen heifers of mixed breeding were used in fifteen experiments. Two heifers were used a second time (Exps 9 and 11) 54 and 90 days, respectively, after excision of the treated ovary at the completion of Exps 1 and 6. Oestrous cycles were recorded by daily observation ofbehaviour in the absence of a bull. Ovaries were injected with various doses of PMSG (Gestyl, Organon) at laparotomy on Day 16 of the cycle (day of oestrus = Day 0) in all but two cases (Exps 3 and 5) which were treated on Day 17. Laparotomy was carried out under general anaesthesia (halothane in N20/02) and injections were given either to the ovary containing (ipsilateral to) the CL or to the contralateral ovary. Four routes of injection were used : intrastromal (i.s.), sub-cortical (s.cort), intra-arterial (i.a.) and intrafollicular (i.f.). Injections by the first three routes were made with a 25or 26-gauge needle, the required dose of PMSG being dissolved in 1-0 ml of 0-9% NaCl. For the first three routes, doses were injected: (1) 1-5 cm into the ovarian stroma (i.s.), (2) just below the surface at two sites (s.cort.), or (3) into the convoluted ovarian artery about 5 cm from the hilus (La.). For i.f. admini¬ stration (Exps 14 and 15), a microsyringe and 27-gauge needle were used to inject each of five follicles (5 mm in diameter) in each treated ovary with 20 i.u. PMSG in 10 μ saline by the technique of Smeaton & Robertson (1971). In Exps 14 and 15, the CL was enucleated at the time of surgery but left in the

Summary Corrosion or latex casts of arteries supplying the uterine horns and ovaries on one or both sides of 30 cows were prepared. The uterine branch (Ramus uterinus) of the ovarian artery (A. ovarica) and especially its anastomosis with the uterine artery (A. uterinus) was larger on the side near an ovary containing a corpus luteum (CL). It is possible that the blood supply to the ovary containing a corpus luteum comprises blood from both the uterine and ovarian arteries. The importance of this relationship to ovarian function was tested by section of the A. ovarica or its R. uterinus, and observing estrous cycles, ovarian morphology and steroid secretion. The results indicate that the anastomosis is necessary for normal cyclic ovarian function. This finding has implications for an understanding of the functional anatomy of the vessels of the genital tract and for the regulation of luteal function. A useful approach to measuring blood flow to the ovary is also outlined. The blood supply to 14 of 16 CL comprised a single primary branch of the Ramus tubarius of the A. ovarica. Other primary branches supply separate compartments of the ovary.

The substrate was injected into an ovarian artery in vivo. Over 15 min. the ovarian veinons blood was collected and analyzed for free and conjugated steroids. In plasma 1.6%, in ovarian tissue 12% of total radioactivity were found to be free steroids, indicating sulfatase activity. In this fraction only progesterone and androstenedione besides pregnenolone could be isolated. After solvolysis of sulfoconjugates only delta-5-metabolites such as dehydroepi-androsterone and androstenediol were detected. It was concluded that free and sulfoconjugated pregnenolone underwent different metabolism.

Various vessels of the uterine vascular system of pregnant guinea pigs were cannulated. The blood pressures were measured. The blood pressure in the beginning of the arterial uterine arcade was found to be around 70% of the blood pressure in the carotid artery when 3 of 10 dilated radial arteries were cannulated. A significant pressure fall occurred along the uterine arcade from the cervical side toward the center. The preplacental pressure was 30% of the carotid blood pressure. The blood pressure in the uterine vein was almost zero. The blood pressure at the origin of the uterine arcade fell to 63% and 51% of the carotid blood pressure when the ovarian artery and the uterine artery respectively were occluded. It was concluded for the pregnant guinea pig

Four experimental sheep with ovarian autotransplants were infused with prolactin (10 or 100 μg/h), into the ovarian artery, for 6 hours and then prolactin together with prostaglandin F2α (PGF2α) (5 μg/h) for a further 6 hours. A control sheep received PGF2α alone, for 6 hours on two separate occasions. Prolactin failed to overcome the luteolytic action of PGF2α in 3 of the 4 experimental sheep.

The luteotrophic properties of LH were examined by determining whether this hormone could overcome the luteolytic action of Prostaglandin F 2α (PGF 2α ) in vivo . Sheep with ovarian autotransplants were given intra-arterial infusions of LH (10 μg/h for 6 h). PGF 2α (5 μg/h) was then added to the infusate and the infusion continued for 6 hours. In all cases, LH failed to counteract the effect of PGF 2α and luteolysis resulted.

PGF2α was administered into the lumen of the uterus, into the uterine artery or into the jugular vein, of pregnant cows and cows in the luteal phase of estrous cycle. Plasma concentrations of PGF2α, progestins, and estrogens were determined. Peripheral plasma levels of PGF2α had returned to normal within 10 minutes after i.v. injection. After intraluminal administration the concentration in uterine venous plasma was elevated for about 15 minutes. All methods of administration caused an initial increase in progesterone secretion, but within one day, luteolysis had occurred, thus resulting in abortion or reduction in the length of the estrous cycle. PGF2α was luteolytic when given intraluminally to cows in which the A. ovarica was sectioned and the blood supply to the ovary was via an alternate route (an anastomosis between the uterine artery and the uterine branch of the ovarian artery). PGF2α did not cause uterine contraction as has been observed in the woman. Intrauterine administration of prostaglandin F2α (PGF2α) causes uterine contractions in the human, and luteolysis in many species including the ewe, cow, and mare. In order to evaluate the potential role of PGF2α as a tool in veterinary medicine the compound was administered to cows during early pregnancy or during the luteal phase of the estrous cycle. The compound was injected into the jugular vein, the lumen of the uterus or the uterine artery. Blood was collected from the jugular vein as well as the veins draining the uterus and ovary in order to determine changes in concentrations of PGF2α, progesterone, and total estrogens.

Publisher Summary The ovary forms part of the female reproductive system. They are situated on each side of the pelvis attached to the posterior aspect of the broad ligament. They receive a rich blood supply from the ovarian arteries, which originate from the abdominal aorta. The ovarian artery joins the uterine artery to form a complex of vessels near the uterine tube. The venous system follows a similar pattern returning blood from the left ovary into the renal vein and from the right ovary into the inferior vena cava. The lymphatic vessels accompany the arteries and veins through the pelvis ending in the aortic lymph glands. Sympathetic and parasympathetic nerves pass down to form a complex around the ovary and control the size of blood vessels serving the organ. The secretions of the ovary perform two separate functions—produces reproductive cells (ova) and hormones (oestrogen and progestagen). Disorders of the ovary involving hormones may be considered in three groups, namely, amenorrhoea, dysfunctional uterine bleeding, and neoplasms and cysts.

Section of the ovarian artery distal to the region where the counter-current transfer of prostaglandin F 2α is believed to take place did not interrupt the estrous cycle. A question is raised as to the role of the counter-current transfer mechanism in luteolysis.

1. 1. Acquired arteriovenous fistulas are commonly caused by traumatic penetrating objects. It is not generally known that arteriovenous fistulas may be a complication following a routine surgical procedure. 2. 2. A review of some of the cases reported in the literature is presented. 3. 3. A review of the literature failed to produce a case of an arteriovenous fistula involving the ovarian artery and vein, as reported herein. 4. 4. A case of an arteriovenous fistula involving the right ovarian artery and vein seventeen years after supracervical abdominal hysterectomy is reported. A surgical cure is obtained.

Dysmaturity as it occurs naturally in animals in the form of runts has been recognised by farmers and stockbreeders for centuries. Runts have been considered a nuisance and as something to be discarded and there has been remarkably little study of them. Investigations of the mechanisms of growth control in experiments using the rabbit (1) and guinea-pig (2), and on the effects of cross-breeding horses of extreme size difference (3) were not concerned with causation of runts but with basic mechanisms of control of normal intrauterine growth.

Patterns of spiral arteries in rabbit1, 2, 3 and human Sovaries4, 5have been described. Although there are differences in the arrangement of these vessels in the two species, homologous parts may be discerned. In the human, the ovarian artery passes along the hilus of the ovary, inosculating with its uterine branch. This may be called the basic branch and compares with the same vessel in the rabbit which lies wholly outside the ovary. There are numerous short tortuous vessels arising primarily from this basic vessel in the human and these primary branches compare with the single (or sometimes double2) ramus ovaricus in the rabbit. In the human, each primary branch normally gives rise to a number of still smaller helical blood vessels that pass in the folds of the posterior duplicature of the broad ligament as this envelopes the ovary. These secondary vessels compare with the ovarian spiral arteries originally described in the rabbit.1, 2 They give rise in turn to clusters of still smaller tertiary spiral ...

Laparoscopy with the 2-incision techniques was performed on a 2 cm unruptured pregnancy in the isthmus of the right tube. Hemostasis was achieved by extensive coagulation of the tubal branches of both uterine and ovarian artery and vein and their anastomosing vessels in the mesosalpinx. In early unruptured pregnancies involving the distal portion of the isthmus or those of the ampulla laparoscopy is the easiest procedure. It would be contraindicated in cases where gestation involved the isthmus of the tube immediately adjacent to the uterus where preservation of tubal function was necessary or where there were numerous adhesions from previous pelvic infection. Advantages of laparoscopy are: 1) decreased operative morbidity 2) absence of surgical scar 3) short hospital stay 4) lower cost to patient.

SEVERE injuries to the ureter requiring surgical repair are less rare than is generally supposed. In the past ten years it has been required in 31 patients on the Urology Division at The Brooklyn and Kings County Hospitals. Radical surgery, such as pelvic exenteration, complete hysterectomy, abdominoperineal resections, and penetrating wounds of the abdomen, has contributed to the increased incidence. Most injuries occur during surgery deep in the anatomic pelvis where exposure is difficult. The point where the ovarian artery crosses over the ureter is a common site of injury. Damage limited to a small segment of 1-2 cm usually results from severing the ureter with a knife or scissors, compressing it with a ligature, or crushing with an arterial forceps. In these instances, the injured area can be resected, the ends spatulated, and joined by an end-to-end anastomosis. This method is particularly suitable when the injury is found during

The contents of pus tubes may not be infectious, but it is desirable to avoid the usual soiling of peritoneal and wound surfaces with any kind of pus. It is, therefore, in the opinion of the writer, better to make a longer incision, to tie the ovarian and ovarouterine arteries and free the specimen at one or both ends or sides before attempting enucleation. The method about to be described can be used in any case; the simple ones are always easy work, but it is in the difficult cases, where there are many adhesions and a large quantity of pus present, that the writer has found the greatest satisfaction in adopting the following plan: METHOD. Clamps are placed upon one of the tubes, closely hugging the uterus. The clamp may embrace about one inch of the broad ligament in its bite. The ovarian artery is either tied or clamped

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The abdomen is to be opened in the usual way and by as free an incision as necessary. Free the uterine mass from adhesions as thoroughly as possible, and draw it up into the incision; draw up the most accessible broad ligament and clamp it just outside of the ovary with a long clamp, the point of which is directed obliquely downward toward the cervix; with a short forceps grasp the upper border of the broad ligament near the uterus, so as to prevent recurrent hemorrhage through the ovarian artery; then sever the broad ligament with scissors, along the clamp first applied. The other broad ligament is then, if possible, to be treated in the same way. A peritoneal flap is now made in front, between the tips of the two clamps; this is best done with scissors; as this flap is dissected up, the bladder is carried with it