Lateral Lithotomy 



443 





below the bladder and beneath the side of the prostate, to reach the 

 penis by piercing the triangular ligament. In the operation of lateral 

 lithotomy such a vessel could scarcely escape division when the 

 incision is being made in the prostate. 



In the female the pudic artery supplies the labia by its superficial 

 perineal branches ; the artery of the bulb enters the vaginal wall, and 

 the terminal branches, which are very small, supply the clitoris. 



To mark the position of the internal pudic artery on the surface of 

 the buttock, see p. 374. 



The internal pudic vein begins as the vein of the corpus caverno- 

 sum and receives branches corresponding to those of the artery, with 

 the exception of the dorsal vein of the penis, which runs straight 

 through the triangular ligament into the prostatic plexus, as shown 

 on p. 413. 



For lateral lithotomy the grooved staff is passed and the stone 



Lithotomy on curved staff. (FEKGUSSON.) 



is struck, cither by it or by the sound the former for choice, for then 

 the operator can be certain that the instrument is in the bladder ; the 

 patient is still lying supine. The assistant takes the staff, and the 

 patient is then placed in the lithotomy position. The surgeon feels 

 for the course of the pubic and ischial rami and the situation of the 

 bulb taking his landmarks, gauging the space. He then introduces 

 his left index-finger into the anus, to feel that the staff has not 

 wandered into a false passage ; that the lower bowel is not loaded 

 with fasces, and bulging over the line of incision ; that the dilated 

 part of the empty rectum is not in undue danger of being incised ; to 

 learn, perchance, the situation of the stone, and to see that the 

 assistant is holding the staff according to his instructions. Then he 



