The science and practice of surgery / by Frederick James Gant.

  • Frederick James Gant
Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: The science and practice of surgery / by Frederick James Gant. Source: Wellcome Collection.

    1230/1320 page 1180
    its removal and through an abdominal aperture of smaller size, than would otherwise be requisite. A large trocar and canula (Fig. 469) is thrust into the most prominent part of the tumour, and the fluid drawn off through the canula. Especial care must be taken to prevent any of the ovarian fluid escaping, or passing from the canula, into the abdominal cavity; and a long vulcanized india-rubber tube fitted to the canula (see Fig. 469) will be the best safegviard. A little alteration of the patient's position, on to her side, and some compression of the abdomen, may prove advantageous in emptying the cyst. If there be no adhesions, the tumour is now seized with a strong vul- sellum and easily drawn out, as a bag, through the abdominal aperture; an assistant or two at the same time following up and closing the wound around the pedicle, so as to prevent any escape of the intestines, by handling the wound with strips of flannel wrung out of warm water. If there be any adhesions, or the tumour be solid, the fingers or hand must be passed into the abdominal cavity; the same precaution being taken by the assistants during this manipulation. When the adhesions are slight and situated anteriorly, they are readily separated by passing the hand round the front part of the tumour. When they are firm, deep- seated and extensive, the operation becomes proportionately difficult and perilous. Fortunately such adhesions are comparatively seldom found posteriorly, or connecting any of the abdominal viscera, except the uterus. These bands should be torn through, and very caiitiously, not to injure the attached organ; any division with the knife being unsafe, on account of the liability to hemorrhage from the vessels which commonly exist in firm, organized adhesions. Any risk of laceration of the attached organ, Fig. 469. as intestine or liver, must, however, be es- ^IG pecially avoided; and it will be more proper to cut across and leave the closely adherent portion of cyst-wall, than incur the danger of visceral rupture. The pedicle protrud- ing through the abdomi- nal incision, as guarded by assistants; the Sur- geon proceeds to secure it. This may be effected either by means of a clamp, or by ligature. The former is especially applicable when the pedicle is long and nar- row ; and various modi- fications in the form of the instrument have been proposed by diffe- rent ovariotomists, each rejoicing in the perfection of his own clamp. The form of clamp devised by Mr. Spencer Wells, is now generally employed. The two blades, com-
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