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Malignant Disease:
Special Procedures

Staging of Gynecologic
Oncology Patients With
Exploratory Laparotomy

Subclavian Port-A-Cath 

Peritoneal Port-A-Cath

Application of Vaginal
Cylinders for Intracavitary
Radiation Therapy

Application of Uterine Afterloading Applicators
for Intracavitary Radiation Therapy  

Pelvic High-Dose Afterloader

Abdominal Injection of Chromic Phosphate

Supracolic Total Omentectomy

Omental Pedicle "J" Flap

Tube Gastrostomy

Total Vaginectomy

Radical Vulvectomy
With Bilateral Inguinal
Lymph Node Dissection

Reconstruction of the
Vulva With Gracilis Myocutaneous Flaps

Transverse Rectus
Abdominis Myocutaneous
Flap and Vertical Rectus
Abdominis Myocutaneous

Radical Wertheim
Hysterectomy With
Bilateral Pelvic Lymph
Node Dissection and With Extension of the Vagina

Anterior Exenteration

Posterior Exenteration

Total Pelvic Exenteration

Colonic "J" Pouch Rectal

Kock Pouch Continent Urostomy

Omental "J" Flap Neovagina

Ileocolic Continent Urostomy (Miami Pouch)

Construction of Neoanus
Gracilis Dynamic Anal

Skin-Stretching System Versus Skin Grafting

Gastric Pelvic Flap for
Augmentation of Continent Urostomy or Neovagina

Control of Hemorrhage in Gynecologic Surgery

Repair of the Punctured
Vena Cava

Ligation of a Lacerated
Internal Iliac Vein and
Suturing of a Lacerated Common Iliac Artery

Hemorrhage Control in
Sacrospinous Ligament
Suspension of the Vagina

Presacral Space
Hemorrhage Control

What Not to Do in Case of Pelvic Hemorrhage

Packing for Hemorrhage

Control of Hemorrhage
Associated With Abdominal Pregnancy

Application of Vaginal Cylinders for
Intracavitary Radiation Therapy

Vaginal intracavitary radiation therapy is applied for two reasons: (1) to treat carcinoma directly in the vagina, the subvaginal mucosa and, in adenocarcinoma of the endometrium, the lymphatic and (2) to add radiation to point A in the isodose curve.

The largest cylinder that can comfortably fit the vagina should be used to achieve the most favorable isodose curve with the lowest surface dose. An intrauterine tandem can be inserted through the vaginal cylinder and can be loaded as the length of the uterus dictates. If the uterus is absent, the cylinders can be used alone to apply radiation therapy to the vagina.

The purpose of applying intracavitary therapy to the vagina is to irradiate the vaginal canal with ionizing radiation. In general, attempts are made to deliver 4000 cGy of radiation to the depth dose of 1.5 cm.

Physiologic Changes. The physiologic changes in this procedure are the same as for all procedures in which ionizing radiation is passed through normal and malignant tissue.

Points of Caution. The vaginal cylinders should be constructed so that they will fill the entire vaginal canal up to, but not beyond, the introitus. Care should be taken that no radium source extends beyond the vaginal introitus for fear that ulceration of the labia minora and majora will occur.

Fixation of the device should be made to ensure that the cylinder will not slip toward the introitus. This usually can be performed by suturing the labia together in the midline.


Cylinders of varying diameter can be easily constructed out of Silastic. The cylinder can be fashioned so that they can be added to each other in tandem to accommodate different vaginal lengths.

If a Fletcher uterine tandem is to be used, it should be inserted into the entire length of the endometrial canal. The vaginal cylinders can then be loaded on the tandem. The radium sources can be inserted through the center of the tandem in a manner that will deliver the desired isodose curve for the uterus, cervix, and vagina.

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