Gynaecology for students and practitioners . carried out entirely from below upw^ards. (c) Pryors Total Hysterectomy. By this method the surgeon pro-ceeds as is done in KeUys continuous left-to-right subtotal hysterec-tomy, excepting that the lateral dissection passes low enough to aUowthe line of amputation to pass across the vagina instead of throughthe substance of the cervix. It is the most expeditious manner of per-forming panhysterectomy. 752 GYNECOLOGY The Radical Abdominal Operation for Carcinoma of the Cervix:Wertheims Operation The principle upon which this operation is based consist
Gynaecology for students and practitioners . carried out entirely from below upw^ards. (c) Pryors Total Hysterectomy. By this method the surgeon pro-ceeds as is done in KeUys continuous left-to-right subtotal hysterec-tomy, excepting that the lateral dissection passes low enough to aUowthe line of amputation to pass across the vagina instead of throughthe substance of the cervix. It is the most expeditious manner of per-forming panhysterectomy. 752 GYNECOLOGY The Radical Abdominal Operation for Carcinoma of the Cervix:Wertheims Operation The principle upon which this operation is based consists in theremoval of infected cellular tissue and glands, and also of enough ofthe vagina to form a capsule for the enclosure of the malignant removal of the latter, the vaginal covering is hermeticallysealed by the application of two strong clamps specially designed forthe purpose {see Fig. 428). Abdominal hysterectomy for cancer of the uterus has been practisedsince 1878. In 1896 Clark successfully carried out the operation of. Fig. 428. Edens Modification of Wertheims Vaginal Clamp. The blades are forged so that the tips come into contact one with another while the heel of the curve is still open. On locking the blades all the tissues included between the tip and the heel are firmly grasped. removal of the uterus and its appendages, with the pelvic cellulartissue, and with the lymphatic glands as high as the bifurcation ofthe common iliac vessels. Wertheim was the first to recognize thenecessity of diminishing the risk of cancer-implantation on the rawsurfaces, and to obviate this danger he devised the plan above men-tioned, hence the operation as now performed goes by his name,although many minor details in the technique have been modifiedfrom time to time. The operation is essentially one for the specialist; this is clearlyshown by Wertheims own statistics, which demonstrate that theprimary mortality, which in his first thirty cases was 40 per cent.,was reduced
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
