Oncology Patients With
Cylinders for Intracavitary
of Uterine Afterloading Applicators
for Intracavitary Radiation Therapy
Injection of Chromic Phosphate
Omental Pedicle "J"
With Bilateral Inguinal
Lymph Node Dissection
Vulva With Gracilis Myocutaneous Flaps
Flap and Vertical Rectus
Bilateral Pelvic Lymph
Node Dissection and With Extension of the Vagina
"J" Pouch Rectal
Omental "J" Flap
Continent Urostomy (Miami Pouch)
Gracilis Dynamic Anal
System Versus Skin Grafting
Pelvic Flap for
Augmentation of Continent Urostomy or Neovagina
of Hemorrhage in Gynecologic Surgery
of the Punctured
of a Lacerated
Internal Iliac Vein and
Suturing of a Lacerated Common Iliac Artery
Suspension of the Vagina
Not to Do in Case of Pelvic Hemorrhage
Associated With Abdominal Pregnancy
of Uterine Afterloading
Applicators for Intracavitary
Therapy for carcinoma of the cervix can be achieved with pelvic irradiation.
It is difficult to deliver appropriate doses of ionizing irradiation
to the cervix with external beam therapy alone. Therefore, the proper
application of intracavitary radiation therapy to the cervix in a manner
that produces an isodose curve that will deliver maximum irradiation
to the cervix, lower uterine segment, parametrium, and upper vagina
It is not the purpose of intracavitary therapy to irradiate
the pelvic wall. This must be done by external beam therapy. To date,
a combination of properly applied paracervical and intrauterine irradiation
along with external beam therapy has given the best results for cure
of carcinoma of the cervix in advanced stages.
The purpose of this operation
is to apply a uterine tandem with symmetrically placed paracervical
ovoids in a manner that will deliver maximum irradiation to the cervix
without excessive irradiation to the base of the bladder or rectum.
Physiologic Changes. Physiologic
changes in this operation are those of ionizing irradiation passing
through malignant tissue.
Points of Caution. It is vital that the cervical
os be identified and the endocervical canal and endometrial cavity
be sounded prior to insertion of the intracavitary therapy applicators.
This can be one of the most difficult parts of this procedure. The
cervical os is generally more posterior than it would seem because
the malignant tissue expands from the anterior lip and distorts the
configuration of the cervix.
The uterine tandem should be inserted into
the entire length of the endometrial canal.
The ovoids should be positioned so that they are in the vaginal fornices
and there is approximately 3.0 cm between the surfaces of the two ovoids.
The upper vagina should not be stretched.
Gauze packing should be applied
in a manner that gives maximum distance between the sources and the
base of the bladder and rectum.
A weighted posterior retractor is placed
in the vagina. The anterior lip of the cervix is grasped with
a wide-mouthed tenaculum, such as a Jacobs tenaculum. Single-toothed
tenacula should be avoided to prevent tearing of tumor tissue.
The cervical os is identified, and the uterus is sounded for
depth and direction. A tapered cervical dilator, such as a K-Pratt
dilator, is used to dilate the cervical canal to 6 mm.
The Fletcher tandem is inserted up to the
uterine fundus, and the flange on the tandem is locked into position.
If perforation occurs and the position of the tandem is in doubt,
diagnostic laparoscopy may aid the surgeon in repositioning the
tandem within the uterus.
The largest Fletcher ovoid is fitted for
size. The largest ovoids that will symmetrically fit into the
vaginal fornices are selected and placed. The upper vagina should
not be stretched. The fulcrum of the ovoid applicator is locked.
The tandem and ovoid applicator
are packed into the vagina, leaving the maximum distance between
the bladder and radium sources.