Trachelotomy

TRACHELOTOMY, the incision of the uterine cervix, which is usually called discission of the cervix (discisio colli uteri). The indication for the operation is a narrow, conical cervix with stenosis of the internal os. The idea of the operation belongs to Sims (M. Sims) (Fig. 1)

Figure 1. Diagram of Sims' bilateral incision: 1 - direction of incisions; 2 and 3 - placement of suture.

and consists in a bilateral lateral incision of the cervix. With a shallow incision of the cervix, the placement of sutures is not mandatory. Subsequently, to prevent hemorrhage and infection, this operation was modified and is performed with the placement of sutures. A. Gubarev incises the cervix with two incisions directed slightly posteriorly from a transverse line drawn through the external os of the cervix. After incising the cervix, the posterior margin of the external os is displaced posteriorly, the external os is enlarged, and this enlargement is fixed by placing sutures. An even greater expansion of the external os of the cervix is achieved when the resulting wound surface after the incision of the cervix is stretched in the sagittal direction and sutured with individual catgut sutures. Pozzi added to this operation the excision of 4 wedge-shaped pieces from the thickness of the cervix at the sites of the cervical incision (Fig. 2a). This makes it possible to achieve a more thorough approximation of the wound edges. Dué modified Pozzi's operation in that he performs the excision of only 2 wedges in the thickness of the cervix, striving to make this as deep as possible in the middle of the wound surface after bilateral

Figure 2: a - Pozzi's operation; b - Dué's modification.

discission of the cervix (Fig. 2b). Thanks to this, according to Faure (J. Faure), the lateral wall of the cervix is thinned and consequently its internal os is expanded. The latter can also be achieved using Nourse's operation (Fig. 3), if the stenosis of the internal os also depends on the curvature of the cervical canal due to retroflexion or anteflexion of the uterine body. During Nourse's operation, the cervix is deeply incised on both

sides down to the internal os. Pulling on the posterior lip, the

Figure 3. Diagram of Nourse's operation; the dashed line shows the direction of the incision.

Figure 4. Effect of incisions during Nourse's operation; from a single pull on the tenaculum forceps, the uterus straightens out. canal is straightened (Fig. 4), and in this position, sutures are placed at the site of the incisions. These operations are usually accompanied by a thoroughly performed dilation of the cervix using Hegar dilators. To secure the result of dilation, Gubarev recommends inserting a rubber drainage tube into the uterine cavity for 9 days. Formerly, such operations were used quite widely for sterility and dysmenorrhea. At the present time, the indications for these operations must be narrowed. In the vast majority of cases, as R. Schröder notes, the result of such operations amounts to a deplorable mutilation of the genital organs. It is very likely that the favorable effect sometimes achieved depends not so much on the incision of the cervix as on the stimulating effect on the uterus and ovaries of dilating the cervix and curetting it. Trachelotomy is frequently used in obstetrical practice, where it bears the name hysterostomatomia sub partu (see).