“The second objection is the difficulty or impossibility of removing all the ovary and tube. If the broad ligament is tense, as it often is in single women, or if it is thickened from inflammatory deposit, it is sometimes impossible to bring the tube and ovary through the abdominal incision and to obtain a pedicle which may be ligated so that we may with safety remove all of the ovary. And it is in just such cases that it is usually most desirable that all ovarian tissue should be removed. “The third objection--the puckering and tension of the broad ligament--may be of less importance than those just considered. However, it seems probable that some of the pain which women suffer after oöphorectomy is due to the traction and counter-traction exerted by different parts of the broad ligament upon a sensitive cicatrix. The broad ligament is pulled up from different directions and converges to the cicatrix, which becomes the point from which the lines of traction radiate. “It was thought that in case of retroversion this tension of the broad ligament would maintain the uterus in place, the ligaments acting as guys. This, however, is not true. Repeated secondary operations have shown that the uterus has fallen back again to extreme retroversion, notwithstanding such methods of ligature of the broad ligaments. “The fourth objection is one which appeals to our surgical sense. It is always better surgery to ligate the vessel alone than to include with it a mass of surrounding tissue.” If the isthmus of the Fallopian tube is diseased, as in some cases of pyosalpinx, so that it is necessary to exsect the tube from the uterine cornu, the second ligature may be passed immediately beneath the tube, including the ovarian ligament and the ovarian artery, but not including the tube; the tube may then be cut out by a wedge-shaped incision in the horn of the uterus. The uterine wound should be closed by interrupted suture (Fig. 212, _A_). In such cases, however, if the tubal disease is bilateral, it is best to remove the uterus as well as the appendages. It is not necessary to place both ligatures before cutting away the ovary and tube. The first ligature may be placed about the proximal portion of the ovarian artery, and then the infundibulo-pelvic ligament may be cut, bleeding from the distal end being controlled with forceps. This will enable the operator readily to bring the ovary and tube through the incision and to ligate the ovarian artery at the uterine cornu. [Illustration: FIG. 212, _A_.--Position of ligatures and sutures in exsection of the tube.] [Illustration: FIG. 212, _B_.--Pyosalpinx which has been exsected from the uterine cornu.]