(3) The cervical canal is cleansed with an antiseptic solution. If a wide
conization is performed, the cervix may be sutured.
2-28. RADIUM INSERTION FOR CERVICAL MALIGNANCY
a. General. This procedure involves the insertion of radium into the cervix for
the treatment of cancer. The procedure may be accomplished with X-ray film control to
ensure accurate placement of the radium. Precautions to protect personnel from undue
exposure are taken, and the procedure is monitored by the radiology department.
b. Operative Procedure--Intravaginal or Intrauterine Application. The
bladder is identified and decompressed by inserting a Foley catheter. The Foley bag is
inflated with a radiopaque medium such as conray for visualization. The patient is
placed on an X-ray table or operating table with a cassette, and radium is inserted.
c. Operative Procedure--Interstitial Application. Radium and cobalt needles
are available in various lengths with a small diameter for insertion into the tissue
surrounding the cervix. They are inserted vaginally with a needle applicator and are
used as a supplement to intravaginal or intrauterine sources. To facilitate removal, the
needles have wires or threads attached to their distal end.
a. General. The diagnostic procedure provides visualization of pelvic structures
through a tubular instrument similar to a cystoscope, which is introduced through a
small incision in the posterior vaginal cul-de-sac. Direct observation of the passage of
dye from the uterus through the fimbriated ends of the tube is possible with the
culdoscope to help determine tubal patency, the presence of ectopic pregnancy,
unexplained abdominal or pelvic pain, the nature of pelvic masses, and to evaluate
normal functioning of the genital tract. This examination may enable the surgeon to
avoid unnecessary pelvic surgery. Laparoscopy is the preferred procedure today.
b. Patient Preparation. The patient is prepared as for a vaginal operation (refer
to paragraphs 2-12 and 2-13). A local or regional anesthetic may be used. When a
general anesthetic is used, the patient is intubated. The patient is usually placed in a
knee-chest position, kneeling on the footboard with a kneestrap around the thighs, the
chest supported on pillows, and the arms comfortably flexed above the head.
c. Operating Room Preparation. Instruments may be placed on a table so that
the surgeon may serve himself. However, there is still need for a circulator. The lens of
the scope may fog if the instrument is introduced cold, so the tip is dipped in warm
water and wiped dry before being used.
d. Operative Procedure (see figure. 2-8).