The pathology and surgical treatment of tumors . Fir,. 247.—Vaginal hysterectomy : first step, opening the posterior ciil-dc-sac 1to the vaginal mucous membrane (after JVlartin). iiturc of the peritoneum CARCINOMA. 363 opened in the removal of a carcinomatous uterus. The vagina and theexternal genitals should be disinfected in the usual manner, and if thecarcinoma has ulcerated extensively, a preliminary scraping is neces-sary for the purpose of removing necrosed infected tissue that wouldescape the ordinary means of disinfection. The patient should undergopreparatory treatment as for laparoto
The pathology and surgical treatment of tumors . Fir,. 247.—Vaginal hysterectomy : first step, opening the posterior ciil-dc-sac 1to the vaginal mucous membrane (after JVlartin). iiturc of the peritoneum CARCINOMA. 363 opened in the removal of a carcinomatous uterus. The vagina and theexternal genitals should be disinfected in the usual manner, and if thecarcinoma has ulcerated extensively, a preliminary scraping is neces-sary for the purpose of removing necrosed infected tissue that wouldescape the ordinary means of disinfection. The patient should undergopreparatory treatment as for laparotomy for a number of days. Bladderand rectum should be emptied before the operation is commenced. The patient must be placed in the lithotomy position, the thighs beingwell separated and properly immobilized. Hegars speculum and re-. FiG. 248.—Vaginal hysterectomy second step ligation of the uterine artery (after Martin). tractors, made for this special purpose, are best adapted for securingaccess to the uterus. The modern improved technique of vaginalhysterectomy has special reference to the prevention and arrest ofhemorrhage. The principal vessels concerned in this operation arewell shown in Figure 246. The uterus is secured and drawn down tothe vulva in the same manner as in supravaginal amputation of the 364 PATHOLOGY AND TREATMENT OF TUMORS. cervix. The operation is commenced by opening the cul-de-sac ofDouglas by a curved incision behind the cervix at its junction withthe vagina, when the vaginal mucous membrane is sutured to theperitoneum (Fig. 247). The suturing arrests the parenchymatous andvenous hemorrhage completely. The next step (Fig. 248) consists inligating the uterine artery on both sides en masse. The left indexfinger is inserted through the wound, and the exact location of theartery is ascerta
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectneoplas, bookyear1895
