The modern operation of hysterectomy as a radical measure for the relief
of cancer of the uterus has a somewhat curious history. In 1878 Freund
extirpated the uterus for carcinoma of the cervix through an abdominal
incision; his method was quickly practised by other surgeons, but the
great mortality of the operation soon caused it to be abandoned for the
vaginal route advocated by Czerny and supported by Schroeder, Olshausen,
Martin, and Péan amongst other gynæcologists. This method, however, has
been abandoned, for, although the operative mortality of vaginal
hysterectomy for cancer of the uterus has fallen to 5 per cent., the
operation has disappointed expectation, as it can only be employed on
early cases of the disease with anything like a hopeful prospect of
curing the patient, and, even when performed on carefully selected
cases, the risks of recurrence are so great and often follow so rapidly
on the operation that surgeons have lost confidence in the method. This
has induced gynæcologists to turn their attention again to the abdominal
route. The cancerous uterus is now subjected to what is known as
‘radical abdominal hysterectomy’, a method with which the names of Ries,
Mackenrodt, Dührssen, and Wertheim are closely associated.
=Hysterectomy for cancer of the cervix.= The greatest obstacle to the
success of vaginal hysterectomy in the radical treatment of cancer of
the neck of the uterus is the limitations which the anatomical
environment imposes on the surgeon, for as soon as the disease overruns
the cervix it implicates the vagina, the bladder, the vesical portions
of the ureters, and the rectum. The ‘radical abdominal operation’
enables the operator not only to remove the uterus and its neck, but the
broad ligament, the ovaries, Fallopian tubes, infected lymph glands, and
the infected para-uterine connective tissue, and by affording the
operator free access to the floor of the pelvis the proceedings may be
carried out with a free exposure of the operating field, thus allowing
important structures like the ureters to be dissected out of implicated
tissue. Indeed it has even been recommended, in cases where the bladder
has been extensively involved, to resect this viscus and engraft the
ureters into the rectum.
The primary object of these extensive operations is not only to
facilitate the wide removal of connective tissue around the cervix in
early cases of carcinoma, but also to allow the advantages of operative
treatment to be extended to patients to whom it would be otherwise
absolutely barred.
Public-domain text, read in full here on John Shaqi.
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