Treatise on gynæcology : medical and surgical . e by means of forceps or the thermo-cautery. If the 258 CLINICAL AND OPERATIVE GYNAECOLOGY. cervical tumor, as in one of Schautas cases, is prolonged above intothe uterus, we should not follow it too far, but limit the operation tothe removal of the accessible part, leaving the base in position, whichwithout doubt will be pushed downward by the uterine contractions,and may then be extirpated. If the tumor has no capsule, we mayamputate it as high as possible, saving two lips, which should thenbe reunited. When there is a clean wound after enuclea
Treatise on gynæcology : medical and surgical . e by means of forceps or the thermo-cautery. If the 258 CLINICAL AND OPERATIVE GYNAECOLOGY. cervical tumor, as in one of Schautas cases, is prolonged above intothe uterus, we should not follow it too far, but limit the operation tothe removal of the accessible part, leaving the base in position, whichwithout doubt will be pushed downward by the uterine contractions,and may then be extirpated. If the tumor has no capsule, we mayamputate it as high as possible, saving two lips, which should thenbe reunited. When there is a clean wound after enucleation, we mayequalize its edges and suture them; but if primary union seems im-probable, it is better to remove the debris of the capsule and packthe cavity with iodoform gauze. B. Pedicled Fibroma of the Body or Polyp.—When the tumor isintra-uterine, it is necessary to do a preliminary operation to renderit accessible; this is best accomplished by the bilateral division of thecervix with strong scissors up to the vaginal insertion. The upper. Fig. 142.— Museux Forceps. portion of the canal is usually dilated by the tumor itself; if other-wise, the part is softened by laminaria tents, and then dilated byHegars bougies; or we may make a bilateral incision (pp. 112 to 118).The ablation of the polyp is ordinarily very simple. The patient isplaced in the dorso-sacral position; the vagina is dilated with a spec-ulum or retractors; and the polyp, being seized with toothed forceps(Figs. 142 and 143), is drawn downward as much as possible while thehand above the pubes examines that the uterus is not inverted. Thenthe pedicle is twisted by imparting to the polyp a movement of rota-tion on its axis, and after two or three turns a pair of strong scissors,curved on the flat, is slid up to the attachment of the pedicle, whichis then divided by small cuts while the torsion continues; this has thedouble effect of aiding the extraction of the tumor and lessening thehemorrhage. The usual ad
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