=Operation.= The cervix is split bilaterally into an anterior and posterior portion by means of scissors, and out of each portion is excised a wedge-shaped piece of tissue, leaving a deep groove. The sutures are passed as in Fig. 62, and the raw surfaces are brought together. _Circular amputation_, as carried out by Hegar, is more suitable for supravaginal elongation of the cervix, the result of prolapsus uteri. The patient is anæsthetized and placed in the lithotomy position and the cervix is pulled down by a volsella and amputated transversely by a knife or scissors. A certain amount of retraction of the stump takes place, producing an inversion of the vaginal wall. The raw surface remaining must be covered by uniting the vaginal and cervical mucous membranes. Sutures are passed in the following manner: a short stout, straight needle, threaded with a loop of silk, is passed from the vaginal mucous membrane, across and beneath the raw surface of the stump, and emerges on the mucous membrane of the cervix (Fig. 63). From eight to ten of these sutures are passed at regular intervals and tied. The sutures are removed on the tenth day and the patient should be kept in bed for fourteen days. [Illustration: FIG. 62. MARCKWALD’S OPERATION FOR CONGENITAL HYPERTROPHY OF THE CERVIX. The wedge-shaped portions have been excised and the sutures passed but not tied. _a,p._ Anterior and posterior lip of cervix before exsection. _e.o.u._ External os uteri. _i.o.u._ Internal os uteri. _s,s'._ Sutures. ] [Illustration: FIG. 63. HEGAR’S OPERATION FOR SUPRAVAGINAL ELONGATION OF CERVIX. The cervix has been removed and four sutures passed but not tied. _c.m.m._ Cervical mucous membrane. _s._ One of the sutures. _sp._ Speculum. _v.m.m._ Vaginal mucous membrane. ] TRACHELORRHAPHY. =Indications.= This operation is performed for the repair of certain forms of laceration of the cervix. It was formerly practised in every case in which a laceration occurred: it is now only permissible in cases in which there is extroversion of the mucous membrane with certain symptoms, such as hæmorrhage or free leucorrhœal discharge accompanied by backache on exertion and general ill health. It was formerly considered that there was a direct relation between cervical laceration and cancer, but further inquiry has failed to corroborate this view. The instruments required are: a Sims’s or Auvard’s speculum; long-handled, angular-bladed knives (right and left); Emmett’s scissors (right and left) (Fig. 64); toothed dissecting forceps; short stout needles with sharp triangular points, straight or very slightly curved. =Operation.= As it is usually found that subinvolution is present and kept up by the laceration, it is best to perform a preliminary curettage (see p. 154) before proceeding to the operation proper. [Illustration: FIG. 64. EMMETT’S SCISSORS (LEFT) FOR TRACHELORRHAPHY.]