Operations for sessile tumours. In submucous sessile fibroids (Fig. 68) in which the lower segment of the uterus is somewhat thinned out and dilated, operative interference may be as follows: Preliminary dilatation of the cervix by bougies may be necessary. The capsule of the tumour is then incised with a sickle-shaped knife and the growth is enucleated by means of the finger or a blunt spoon. In some cases mere incision of the capsule is sufficient, and the uterus expels the growth later on.
Fig. 68. Submucous Fibro-myomata, capable of Treatment by Morcellement. (From drawings made at time of operation.)
Another method of treating these cases is by the operation of morcellement, which consists in removing the tumour piecemeal by means of specially made forceps.
The instrument used by the author consists of a strong pair of forceps somewhat like those used in lithotomy, with the two distal ends notched with sharp teeth like a volsella. A portion of the tumour is seized between these two blades, and partly cut and partly twisted off. With patience and care the whole tumour may be thus removed. In one case the author was enabled to remove two large growths, each filling a pint measure. This operation is specially suitable in women in whom an abdominal operation is to be avoided.
Operations for interstitial tumours. Interstitial fibroid tumours, if not above the size of a small fœtal head, should be treated by vaginal hysterectomy (vide infra); if large, by hysterectomy by the abdominal route (see [p. 36]).
Vaginal hysterectomy. By vaginal hysterectomy is meant removal of the whole uterus by the vagina, with or without the appendages. The advantages that the vaginal operation possesses over abdominal hysterectomy are, there is less disturbance of peritoneum and intestines, less shock, and no abdominal scar or risk of subsequent hernia. The operation is limited to uteri not exceeding in size the head of a full-time fœtus.
Indications. (i) Malignant disease of the uterus (fundus or cervix) in an early stage: chorio-epithelioma malignum.
(ii) Certain cases of fibro-myoma of the uterus.
(iii) Certain cases of inflammatory disease of the uterine appendages complicated by recurrent attacks of local perimetritis.