A System of Operative Surgery, Volume IV (of 4)

uterus for carcinoma of the cervix through an abdominal incision; his method was quickly practised by other surgeons, but the great mortality of the operatio

th anything like a hopeful prospect of curing the patient, and, even when performed on carefully selected cases, the risks of recurrence are so great and often follow so rapidly on the operation that surgeons have lost confidence in the method. This has induc

l portions of the ureters, and the rectum. The 'radical abdominal operation' enables the operator not only to remove the uterus and its neck, but the broad ligament, the ovaries, Fallopian tubes, infected lymph glands, and the infected para-uterine connective tissue, and by affording the operator free access to the floor of the pel

nnective tissue around the cervix in early cases of carcinoma, but also to allow the advantages o

soiled with cells, which engraft themselves on this tissue and on the peritoneum, and give rise to extensive masses of cancer which are often described as recurrent cancer. This accident often causes the patient to die quicker t

ical abdominal operation advoca

e Trendelenburg position is indispensable and the abdomen is opened by a free median subumbilical incision. After isolating the intestines with dabs, the ureters are exposed by incis

sels are secured in the following manner:-The index finger is pushed along the ureter through the parametrium towards the bladder, until the tip of the finger appears there; the vessels are then raised on the finger, which covers

m the vagina: at this stage the uterus is sufficiently isolated from the surr

elvic wall, and the vagina closed with bent clamps and divided below them: th

e iliac vessels laid bare, and every enlarged gland from the division of the aor

reated in the

to the vulva. An exact closing of the peritoneal cavity over this gauze is effected by the sewing up of

gh the vagina in from five to ten days successively. The patient gets up on the fifteenth

eck of the uterus is very high, more than 20%, but recent statistics (1909) show that this dea

operation are sepsis, cancer-inf

operation, and they are sometimes accidentally divided. It is not uncommon to find a ureter completely blocked

the application of iodine or sulphate of copper. It is, however, unfortunately true that many patients

trial in Great Britain. The operative mortality is very high, and no

removing not only the uterus and its neck, but both ovaries, Fallopian tubes, mesometria, and any enlarged lymph glands that are detected. In the course of the operation the surgeon should avoid any undu

ry cancer of the corporeal endometrium. The mass measured 10 centimetres transverse

ll atrophic uteri. These small uteri may sometimes be extirpated by the vagina, but often the

render its removal by the vaginal route difficult as well as undesirable. When this form

the massive form, because the cervical canal being narrow, pathogenic micro-organisms do not obtain such free ingress as in the case of wome

s, but since its frequent association with fibroids has been recognized (see p. 52) mainly as a consequence of t

greater than after removal of the uterus for fibroids. This is due to the fact that when the cancer u

is compact, as in Fig. 19, good results may be expected. When the growth has perforated the uterine wall and small bud-like processes project on t