Text book of abdominal surgery : a clinical manual for practitioners and students . is seldom difficult; theperitoneal covering of the tumour is cut through close above it,and it is separated downwards, bleeding vessels being caught upwith forceps and tied. A neck or pedicle will now have beenformed with the loss of almost no blood. Another way of forming this neck is to make a circular 44^ FIBROID TUMOURS OF THE UTERUS. incision through the capsule or peritoneal covering of thetumour at its widest diameter, forceps are fixed on to everybleeding vessel, and the capsule is then separated downwa
Text book of abdominal surgery : a clinical manual for practitioners and students . is seldom difficult; theperitoneal covering of the tumour is cut through close above it,and it is separated downwards, bleeding vessels being caught upwith forceps and tied. A neck or pedicle will now have beenformed with the loss of almost no blood. Another way of forming this neck is to make a circular 44^ FIBROID TUMOURS OF THE UTERUS. incision through the capsule or peritoneal covering of thetumour at its widest diameter, forceps are fixed on to everybleeding vessel, and the capsule is then separated downwardsall round until a neck is reached. In cases where the broadligaments reach high up on the tumour, they are usuallypartially separated in the way previously described, before thecircular incision through the capsule is made. This separationof the capsule causes great loss of blood, and does not appearto have any special advantage over the other plan. It alsoinvolves a certain amount of danger, as the separation may becontinued too low down, and in this way septic matter may be. Fij;. 31.—Keiths Hysterectomy Clamp. shut up in the tissues below the clamp or wire. When theformer method is used the clamp or wire fixed on to the neck isin contact partly with the peritoneum at the back and front ofthe uterus and partly with the raw surface at the sides; while inthe latter method it is in contact with peritoneum all round. The extra-peritoneal method consists in fixing the neckwhich has been formed into the lower angle of the wound, andbefore this can be done it must be constricted in one way oranother. It is best done by the clamp of which a diagram isgiven. It is much the same shape as Wells ovariotomy clamp,but is much longer, being nine inches in length including thehandles, thinner, and fitted with movable handles so arrangedthat they cannot slip when the clamp is used. A single ligatureis placed round the stump to prevent it spreading out too much; HYSTERE CTOMY. aa: the cla
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectabdomen, bookyear1894
