206 



OPERATIVE TECHNIQUE. 



turned until the spermatic cord tears through. As a rule fifteen 

 to twenty turns are necessary, sometimes even more. Where a second 

 forceps is used for twisting it should not be applied too near the first, 

 a space of f inch or ij inches being left between the two. 



After dividing the non-vascular portion of the cord with scissors 

 the best method is to grasp the vascular part about § inch to ij inches 

 above the epididymis with forceps, and compress it firmly. The testicle 

 is then grasped with both hands and rotated as above described. The 

 vas deferens breaks first, whilst, on account of their greater elasticity, 

 the blood-vessels, especially the spermatic artery, are the last portions 

 to yield. Special care is therefore needed towards the latter part of 

 operation. The vessels should never be torn through, but torsion 

 should be continued until the cord is completely divided. By pulling 



Fiu. 237. — Bayer's forceps in use. Many operators prefer Toil's forceps, wliich 

 roll the cord together into a cylindrical mass I see text). 



on it the elastic artery is drawn from within the shelter of the other 

 tissues, and being no longer surrounded and supported by them, is apt 

 to bleed. The \essels having been twisted thron,^h, the testicle is 

 placed on one side, and the fixation torceps slowly and cautiously 

 relaxed. Should bleeding occur the forceps are again closed, the 

 bleeding vessels grasped with Wells forceps and twisted, or ligatured 

 with the above-mentioned precautions. Should the bleeding cord slip 

 beyond the forceps, it may be regained by first seeking the processus 

 vaginalis, and passing the fingers within. After operation is com- 

 plete care must be taken that the cord returns within the processus 

 vaginalis, and that the edges of the scrotum are drawn somewhat 

 downwards. 



