Circular Amputation of the Cervix 635 



outside of which is the fibro-muscular tissue without its 

 covering of vaginal mucosa. Grasping the superior segment 

 and pulling sharply upward in order to expose the endocer- 

 vix to the greatest possible extent, a semi-elliptical incision 

 is made through the endocervical mucosa, connecting the 

 anterior ends of the longitudinal incisions. The convexity 

 of the incision is directed posteriorly. The scalpel is now di- 

 rected, parallel to the incised margin of the mucosa, towards 

 the uterus for a short distance in order to free the margin 

 for the placing of sutures. The directions of the amputating 

 incisions thus form a more or less V-shaped declivity in the 

 posterior extremity of the stump, the mucosal margins of 

 which may be brought together readily with sutures. The 

 free edge of the endocervical mucosa is now secured by 

 toothed fixation, or by fine artery forceps. Using chroma- 

 tized catgut sutures No. 1 to 3, and a % or full-curved needle 

 with a piercing point, the free margin of the vaginal mucosa 

 above is brought into apposition with the endocervical mu- 

 cosa below. Usually four or five sutures are necessary in 

 apposing these margins. (See Fig. 202.) 



When any considerable portion of the cervix has been re- 

 moved, it leaves the vaginal mucosa, which has been sepa- 

 rated from it, free from its underlying support. In order 

 that part of this vacant space may be eliminated, and in or- 

 der to prevent too great a strain upon the endocervical mar- 

 gin, a small portion of the fibro-muscular cervical tissue 

 should be included in each suture (Fig. 203, 204). 



The lower segment of the cervical core is now excised and 

 sutured in the same manner. The endocervix has thus been 

 brought into coaptation with the vaginal mucosa both above 

 and below. At the lateral commissures of the os, the vaginal 

 mucosa sags away from the endocervical mucosa. Lateral 

 to this, on each side, an excess of vaginal mucosa results 

 from the marked diminution in the size of the external os — 

 often a reduction in diameter from as much as 5 or 6 inches 

 to about \U inch. Coaptation of the vaginal mucosa to the 

 lateral margins of the endocervical mucosa is now secured 

 by passing on each side a suture through the vaginal mu- 



