Present status of operations for cancerous uteri / Howard A. Kelly.

  • Howard Atwood Kelly
Date:
1900?]
Catalogue details

Licence: In copyright

Credit: Present status of operations for cancerous uteri / Howard A. Kelly. Source: Wellcome Collection.

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    when it is splinted by the bougie. In a vaginal opera¬ tion the difficulties of recognizing the ureter are some¬ times almost insurmountable if it is not catheterized. This plan, first put into practice by Pawlik, by slipping a bougie into the ureter through a director and through the water-distended bladder, has for the first time been generally practicable as a routine procedure by my aerocystoscopie method. Further, the disease rnust he given a wide berth by ligating far out in the parametrium and, if necessary, dissecting out the ureters, and on the vaginal side by cutting far below the manifestly affected area. I have now gone as far as I am able to go with as¬ surance : if these principles are borne in mind any opera¬ tive procedure whatever, which is based upon them, will give results vastly better than those we have secured hitherto. Clarkes operation, so thorough in its wide dissection, must receive a most careful consideration. A large series of statistics must show us just how often glandular metastases are to be found in operable cases, then by comparing this fact with the increased risk to life from the more prolonged difficult abdominal opera¬ tion, we will be in a position to decide whether the im¬ mediate danger incurred is or is not less than the risks of recurrence of the disease in the glands. Having in mind the risks of inoculation of the can¬ cer in the cellular tissues, X. 0. Werder, of Pittsburg, Pa., has devised an admirable operation which is at present being extensively tried by Hr. W. W. Rus¬ sell, my associate professor of gynecology in the Johns Hopkins University. This consists in a com¬ bined abdominal and vaginal enucleation, opening the abdomen and ligating and freeing the uterus on all sides, together with the upper part of the vagina. The removal is then affected via the vagina, by simply pull¬ ing the cervix well down to the vulva and cutting through the vagina at the lower limit of its detachment. In this way there is the least possible contamination. I have tried this operation and am greatly impressed by it. My most earnest efforts have, however, been turned in another direction, and I will close by briefly describ¬ ing the operation which I have recently devised and practiced in the cases cited at the end of this paper.
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