File:Gynecology (1916) (14780053215).jpg

Identifier: gynecologygrav2 (find matches)
Title: Gynecology
Year: 1916 (1910s)
Authors: Graves, William Phillips, 1870-1933
Subjects: Gynecology Genital Diseases, Female Women Gynecology
Publisher: Philadelphia and London : Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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ritoneal adhesions. In these cases the land-marks become confused and the usual planes of cleavage between tissues arelost. The same is true in operating on cases that have been treated by radium. EXTENDED VAGINAL HYSTERECTOMY FOR CANCER OF THE CERVIX The operation developed by Schauta is a very difficult one, and should beattempted only by those familiar with the vaginal route for performing pelvicsurgery. The illustrations of this operation are adapted from Schauta. HYSTERECTOMY OPERATIONS 645 The cancerous area is first thoroughly cureted and cauterized. The opera-tion is then performed by the following steps: (1) Circumcision of the Lower End of the Vagina.—A circular incision ismade around the circumference of the vagina at the introitus, and the vaginalwall dissected away for the distance of about 2 inches. In this way a cuff isformed the open end of which is closely sewed with interrupted sutures, theends of which are left long and included in a clamp. The vaginal cuff is now
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Fig. 351.—Schautas Operation for Cancer of the Cervix. Initial circumcision of the vagina. Fig. 352.—Schautas Operation for Cancer of the Cervix. The vaginal cuff is being dissected. held forward by the sutures, and the separation of the vagina continued alongits lateral and posterior wall, care being taken not to injure the rectum. Thedissection of the vagina from the rectum should be carried out with blunt scis-sors rather than by stripping with gauze. (2) Paravaginal Section.—When the vagina has been well freed from therectum a deep incision is made in the left lower angle of the vaginal bed, extend-ing first laterally to the lower end of the left labium minus, then turning down-ward parallel to the rectum and to the left of it, separating the fibers of the 646 GYNECOLOGY

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