Hysteromyomectomy : with a report of four cases / by Hunter Robb.

  • Robb, Hunter, 1863-1940.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Hysteromyomectomy : with a report of four cases / by Hunter Robb. 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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    HYSTEROMYOI [From The Johns Hopkint By Hunter Robb, M. D., Associate in Gynecology to the Johns Hopkins Hospital, Baltimore, Md. The removal of the uteru i for large myomata becomes an operation of necessity in many cases, and the choice of a method will naturally he that securing the greatest amount of safety to the patient, and this hinges largely upon the treatment of the pedicle. Many of the methods adopted in the past for the disposi- tion of the pedicle neither secure asepsis at the time of opera- tion nor afterwards : there is often, as well, an undue waste of time in carrying out the various steps of the operation. In passing judgment upon any operation of this kind one must think particularly of the dangers of sepsis and hemorrhage and of the length of time consumed. When the pedicle is dropped into the peritoneal cavity the hemorrhage has frequently been fatal, or sepsis has occurred from the stump. These two dan- gers have strongly militated against this method of treating the pedicle. Even in cases where the pedicle has been sus- pended, drainage has often been thought necessary to carry off fluid escaping from the stitch-holes and accumulating in the pelvis. I do not believe that hemorrhage need ever occur with a proper careful treatment, any more than after the transfixion of an ovarian pedicle; nor should the dangers of sepsis be much greater. In every case demanding operation I feel confident that the plan I have adopted and am about to describe can be followed. It is particularly suited to cases in which the uterus is in- volved throughout its substance, as it leaves the cervix for the most part intact, and permits the lower part of the uterus to be raised out of the pelvis. Method.—After opening the peritoneal cavity, the body of the uterus, the cervix and broad ligaments are carefully ex- amined and the situation studied. The myomatous uterus is