Technique of the radical abdomino-perineal (Miles's) operation.

England, 1933.

1 encoded moving image (35.49 min.) : silent, black and white

00:35:49

Segment 1 An incision is made in the abdomen. The edges of the wound are retracted. The pelvic colon is found to be bound by extensive adhesions, so a 'tedious and difficult' dissection is necessary to remove it. The area is inspected for any presence of tumours. The loop of the pelvic colon is drawn through the incision and blood vessels are ligatured. Time start: 00:00:00:00 Time end: 00:06:12:20 Length: 00:06:12:20

Segment 2 The peritoneum is divided. The prescaral space is opened up. The ligaments of the rectum are divided. The rectum is freed from its attachments. Preparations are made to sever the pelvic colon. Time start: 00:06:12:20 Time end: 00:11:59:23 Length: 00:05:47:03

Segment 3 The pelvic colon is crushed one hand's breadth from the end of the descending colon. The crushed area is ligatured at either end. The bowel is divided between the ligatures. The end of the isolated bowel is tucked down into the presacral space. The peritoneal floor of the pelvis is re-established. Time start: 00:11:59:23 Time end: 00:17:59:21 Length: 00:05:59:23

Segment 4 The peritoneal floor of the pelvis is re-established. A circle of skin is excised. A stab incision is made through the abdominal wall. The remaining part of the pelvic colon is drawn through the stab incision and fixed to the skin edge. The abdominal wound is closed. The position of the patient is changed for the next step of the operation. The anus is closed with sutures. Time start: 00:17:59:21 Time end: 00:24:25:24 Length: 00:06:26:03

Segment 5 An incision is made around the anus. The flaps of skin are dissected up and the coccyx is removed. The closed end of the pelvic colon is drawn through the wound. A dissection is made and blood vessels are secured. The cavity is sponged out. Time start: 00:24:25:24 Time end: 00:30:31:23 Length: 00:06:05:24

Segment 6 The cavity is lined with a protective material. The skin flaps are sutured in position. The pelvic colon is cut away to establish the colostomy. The rectum is laid open displaying the cancer. The section of the bowel with the tumour is displayed to the camera. Time start: 00:30:31:23 Time end: 00:35:49:09 Length: 00:05:17:11

Produced by W. E. Miles

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Copyright previously held by British Medical Association and assigned to Wellcome in 2005