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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

Abdominal Injection of
Chromic Phosphate ()

is indicated in those cases of ovarian carcinoma where all bulk disease has been removed, and it is necessary to destroy tumor cells or micronodules of tumor less than 4 mm in diameter.

Although a Silastic catheter can be inserted at the time of laparotomy, it should not be exteriorized but left in a subcutaneous pocket, because if it is exteriorized, by the seventh or eighth postoperative day it will be grossly contaminated and the patient will be at risk for peritonitis. Care should be taken to ensure that there is no drainage of fluid from old closed suction drain sites prior to injecting the radionucleotide.

The purpose of the operation is to inject into the peritoneal cavity in a manner that will allow free flow of the fluid throughout the peritoneal cavity. It should deliver 6000 rads to a depth of 3 mm on the peritoneal surfaces.

Physiologic Changes. is an emitter of a beta particle. The penetration power of a beta particle is 4 mm. It has its effects on cells and micronodules of tumor. It is not effective against bulk tumor.

Points of Caution. It is imperative that the paracentesis needle be properly placed in the peritoneal cavity and not in an organ or a pouch formed from postoperative adhesions.


The patient is placed in the supine position on the radiology fluoroscopy table. A 16-gauge needle is used to perforate the anterior abdominal wall under local anesthesia. A Silastic catheter is threaded through the needle into the peritoneal cavity, and a test dose of radiopaque dye and saline solution is injected under fluoroscopic control. If the dye diffuses throughout the abdomen and there is no pooling, the position of the catheter is accepted.

is drawn up in a syringe, attached to a three-way stopcock, and injected in one push. A container of intravenous saline solution is then attached to the other arm of the three-way stopcock, and 1000 mL are allowed to flow into the peritoneal cavity, diluting the and promoting a flow of the radionucleotide throughout the abdomen.

The patient is rotated from side to side and from the Trendelenburg to reverse Trendelenburg position to facilitate the spread of the radionucleotide over the liver, under the diaphragm, and throughout the peritoneal cavity.

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