Special Surgical Procedures II
LESSON 2: Procedures in Gynecological and Obstetrical Surgery
Section Ii:
2-23
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 sound; urinary drainage may or may not be established; vaginal dressings are applied and held in place with nonirritating plastic tape and a binder.
