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Abdominal Total Hysterectomy. A New Technique: The Posterior Approach

JAMA. 1957;165(10):1350-1351. doi:10.1001/jama.1957.02980280124026.
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This monograph describes a new technique of hysterectomy which has been performed by the author 1,000 times without a death and with practically no postoperative morbidity. The operation is a modification based on an appreciation of both pelvic anatomy and genital function. It affords a precise anatomic route, conserves the vaginal supports, and enables removal of the uterus with safety to the urinary tract. The special features of this new technique, entailing a systematic posteroanterior approach, include early mobilization of the uterosacral ligaments, preparation of a large peritoneal flap posteriorly, separation of the bladder from the vagina by direct vision over the finger of the operator placed in the vagina through a posterior window therein, ligation of the uterine vessels without the use of clamps, removal of the uterus between a pair of newly designed curved clamps, and shortening of the uterosacral ligaments by attaching them to the vaginal vault


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