File:Manual of operative surgery (1921) (14804482053).jpg

Identifier: manualofoperativ1921binn (find matches)
Title: Manual of operative surgery
Year: 1921 (1920s)
Authors: Binnie, John Fairbairn, 1863-1936
Subjects: Surgery, Operative
Publisher: Philadelphia : Blakiston
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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patient remained welluntil lost sight of three years later. Gregoire and Chevassu later performedfour similar operations with encouraging results. Hinman (Surg., Gyn. andObst., May, 1919) reports five cases in which he operated successfully. Step I.—Dorsal position. Make an incision into the inguinal canal. Ex-pose and free the cord high up. Divide the cord with the cautery betweenclamps. Excise the testicle. If immediate examination of the specimen provesit non-malignant complete the operation by attending to hemostasis and closingthe canal and wound. If malignancy is present proceed to Step 2.—Place the patient midway between the lateral and dorsal positions(diseased side uppermost) with a medium sized pad under the opposite costalmargin. The position is bent dorso-lateral. TERATOMA TESTIS 741 Continue the original incision ui)war(ls and outwards, sjilitting the externaloblique in the direction of its libers to a point about 2 cm. (% in.) internalto the anterior superior spine.
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f^va glanola -^x-terrial iViac a --j^SmMStOi^^it^i^ Fig. 907.— (Hinman, Surg. Gyn. &° Ohsl.) From this point continue the cut in a curved direction to about i cm. belowthe tip of the twelfth rib and carry the cut parallel to the rib for about half itslength. Divide the internal oblique, transversalis and latissimus dorsi in theline of incision. In this exposure the iliac branch of the ilio-hypogastric nerveis necessarily sacrificed. Expose but do not injure the peritoneum, Fig. 907. 74: OPERATIONS ON THE TESTICLES Step 3.—Separate the parietal peritoneum from the posterior abdominalwall. The spermatic vessels as well as the ureter tend to strip up \\\xh. theperitoneum. To overcome this exercise gentle traction on the cord during thestripping. At this point where the vas deferens passes down behind the blad-der the peritoneal boundaries may be with difficulty outlined. This dissectionshould be carefully completed before proceeding with that above. Divide thevas where it disapp

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