File:Annals of surgery (1885) (14583147838).jpg

Identifier: annalsofsurgery78philuoft (find matches)
Title: Annals of surgery
Year: 1885 (1880s)
Authors:
Subjects: Surgery
Publisher: Philadelphia Lippincott
Contributing Library: Gerstein - University of Toronto
Digitizing Sponsor: Internet Archive

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this operation a number of times on cadavers, and was impressed withits feasibility. \\ithin the past year it has been em))l()yed twice on human beings. The following steps, somewhat modified from the original jniblication,were carried out: 1. Make an incision from one inch below the umbilicus to a jx)int over themiddle of the pubis, as is shown in Fig. i. 2. Expose the bladder in the same manner as in an ordinary supra-pubic operation. 793 GEORGE WALKER 3. Open the bladder to confirm the chagnosis and to ascertain the extentof the invasion of the vesical neck. (See Fig. 2.) 4. Cut through the cartilage joining the pubes. and separate the honesslightly. Then divide the pubic ligaments and attachments of the triangularligament. This should be done with a blunt-pointed knife. 5. Place the special retractor between the cut ends of the bone and
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Membr- Ure+h-rot .^X Fig. 2.—Bladder opened for confirmation of diagno nd for invasion of vesicle of i sejiarate the surfaces as widely as desired. Abduction of the legs aids theseparation. (See Fig. 8.) 6. As the bones are separated, the prostate comes into view. The lateralsurfaces of the gland are then freed from the surrounding tissue by theoperators hand. This separation is carried down to the rectal wall. 7. The urethra is now cut across at its juncture with the prostate. 8. The prostatic end of the urethra is grasped with the forceps andpulled upward and forward so as to allow the prostate to be dissected, underview, from the rectum. This should be done with great care. The dissectionis carried well up toward, but not quite, to the bladder. 9. Divide the bladder transversely as near the vesical neck as is war- 796 TRANSPUBIC REMOVAL OF THE PROSTATE

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