Aseptic surgical technique : with especial reference to gynaecological operations : together with notes on the technique employed in certain supplementary procedures . c growths. Before thesac is punctured it is well to place a large sponge orpiece of gauze round it, in order to absorb any fluidwhich we might otherwise not be able to any fluid or particles of papillomatous growthsin spite of our efforts have been carried into the ab-dominal cavity, they should be carefully sponged collection of pus before being opened into mustalways be walled off from the peritoneal cavity.
Aseptic surgical technique : with especial reference to gynaecological operations : together with notes on the technique employed in certain supplementary procedures . c growths. Before thesac is punctured it is well to place a large sponge orpiece of gauze round it, in order to absorb any fluidwhich we might otherwise not be able to any fluid or particles of papillomatous growthsin spite of our efforts have been carried into the ab-dominal cavity, they should be carefully sponged collection of pus before being opened into mustalways be walled off from the peritoneal cavity. After the diseased parts have been excised and thepedicle firmly ligatured, the surgeon makes the peri-toneal toilette. If there has been no escape of fluidand no free oozing into the abdominal cavity, it is not AN ASEPTIC OPERATION. 171 necessary to employ any irrigation, and it will be suffi-cient if the peritoneal cavity be sponged dry, particu-larly the portion posterior to the uterus. To do thisthe uterus is held well forward with the left hand, sothat the sponges can be carried well down into thecul-de-sac. (Fig. 30.) All ligatures should now be Fig. Sponging out cul-de-sac. well inspected before the ends are cut off, and, if thereis little or no oozing and the pedicle does not retractfrom the ligature, the latter may be cut off about onecentimetre from the knot. When adherent structures are to be removed thetechnique to be carried out is more difficult than whenthey are free. It is in these cases that the larger ab-dominal incisions are required. Fortunately, adhesionsare more rare now than of old, since patients submit to 172 ASEPTIC SURGICAL TECHNIQUE. an operation earlier and the previous puncture of theabdomen for diagnostic purposes or for drawing offfluid is less common. If the intestines obstruct thefield of operation, they can be kept out of the way bypushing them back and covering them with a largesponge or with a large piece of sterilized gauze wrungout o
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