Vaginal hysterectomy for malignant disease of the uterus / by J.E. Janvrin.

  • Janvrin, J. E. (Joseph Edward), 1839-1911.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Vaginal hysterectomy for malignant disease of the uterus / by J.E. Janvrin. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    tures my preference is decidedly in favor of ligation. If the uterus can be drawn down sufficiently to permit the finger, introduced through the posterior opening, to pass around the fundus and hook over the broad ligaments, then a pair of forceps sufficiently long, can be made to include the entire ligament, the finger meanwhile protecting against nipping the intestines by the points of the forceps. When this can be done there is but one objection to it, and that is that the mass included being the entire broad ligament is quite large, and more sloughing is likely to occur than in cases in which the ligatures are applied. In several of my earlier operations I have applied the forceps, one to each broad ligament, in this man- ner and with perfectly satisfactory results, removing them at the end of thirty-six hours. The use of several pairs of forceps to either broad ligament is objectionable on account of their bulk, their inconvenience, and the pain and discomfort which they often cause. In addition to this they interfere greatly with the gauze dressing and entail after manipulations which are not necessary where we use ligatures. In applying ligatures an extra large Peaslee needle, curved at a right angle and blunt pointed, generally accomplishes the purpose easily. Drawing forcibly down upon the cervix the needle, threaded with sufficiently strong silk, is carried far enough up to include the lower third of the ligament. Perforating the ligament from its anterior surface the ligature is grasped by a tenaculum and held while the needle is unloaded and withdrawn. The uterine artery is thus included in the first ligature. This portion of the ligament is then cut through by scissors (and the traction upon the cervix almost completely prevents haemorrhage from the uterine side of the cut ligament) and one or two more ligatures are rapidly applied. The same steps are much more easily applied to the remaining ligament. In some cases where the broad ligaments are shortened, or the vagina is small, or the uterus so large as to prevent its being drawn down to the vulva I have made use of a needle specially devised for such cases. I have had this needle, or rather “ligature carrier,” made by the Ford Surgical Instrument Company. It is constructed upon the principle of the Sims’ uterine repositor. and with it the ligature can generally be passed with comparative ease even when circumstances are such as to absolutely preclude the use of the needles ordinarily used for this purpose. The uterus having been removed slight traction upon the liga- tures, which have purposely been left long, usually brings the ovaries and tubes into view, and they are readily ligated and re-