b. Operative Procedure.
(1) The anterior lip of the cervix is grasped with a Jacobs vulsellum forceps.
The canal is sounded and dilated to either visualize or palpate the base of the pedicle.
(2) If the pedicle of the tumor is thin, a tonsil snare may be placed over the
body of the tumor, permitting the snare to crush the base of the tumor and to control
bleeding. If the tumor is large, its base is dissected out with a knife. Bleeding is
controlled by the use of warm, moistened gauze sponges on holders.
(3) Retractors are withdrawn; vaginal packing may be introduced into the
cervical canal. The tenaculum is removed from the cervix, and a dressing applied and
held in place with a binder.
2-23. AMPUTATION OF THE CERVIX
a. General. This operation involves the removal of a portion of the portio
vaginalis of the cervix. This cervical amputation, without repair of the pelvic floor, is
usually done in the presence of an intraepithelial cancer, with preservation of the
remainder of the female genital organs. In specific cases, such as mycotic or venereal
infections of the cervix, this may be done by excision of the cervix.
b. Operative Procedure.
(1)
A dilatation and curettage may be performed before excision of the
cervix.
(2) The labia are retracted; the cervix is grasped with a Jacobs tenaculum
and drawn sharply downward.
(3) A circular incision is made through the full thickness of the vaginal wall
by means of a knife. The distal end of each cardinal ligament is clamped, cut, and
ligated, using Heaney clamps, long curved Ochsner forceps, scissors, and chromic gut
number 0 ligatures.
(4) A portion of the portio vaginalis of the cervix is amputated by an oblique
circular incision; the canal is coned, using a knife. Bleeding vessels are clamped and
ligated with chromic gut number 0 ligatures.
(5) Anterior and posterior Sturmdorf sutures of chromic gut number 0 and
number 2-0 on 1/2-circle, trocar-point needles are placed. Bleeding vessels are
clamped and ligated.
(6) The vaginal wall flaps are approximated, covering the denuded cervix by
means of six to eight interrupted chromic gut number 2-0 and 0 sutures swaged to
1/2-circle, taper point needles. The patency of the cervical canal is tested, using a
MD0928
2-21