Each time that rectal dissection is laborious, the integrity of the rectum is checked by injecting methylene blue or testing with a gas. The position and direction of the ureters should be regarded with caution, as they may even touch the nodule. They must be identified with certitude, which most often implies dissecting them. Undesirable coagulations close to the ureter should be avoided, and a minimum amount of bleeding tolerated. Once the ureters have been freed, the exeresis is continued to the utero-sacral ligaments, which are often affected by this disease.
Partial resection is often necessary.
Once the rectum and ureters have been cleared, the main dangers are eliminated. The nodule remains in contact with the vagina and the posterior face of the uterus. A vaginal touch will allow the relationships between the nodule and the vagina to be better appreciated. All indurated zones must be removed, cutting wide in soft tissue so as to avoid leaving any pathological tissue. Vaginal resection is therefore commonplace, and practically systematic for large nodules.