TORSION OF THE SPERMATIC CORD. 187 



twice, and the blood-vessels are divided without having first been 

 sufficiently twisted. Bleeding is then very liable to occur, especially 

 if a second forceps be used for twisting, and if the hold on the 

 spermatic cord be too short. To ensure regular torsion the sper- 

 matic cord should first be rolled together into a cylindrical mass, as 

 occurs in using Togl's forceps. As, however, with Togl's ordinary 



Fig. 233. — Bayer's forceps with screw and instantaneous 

 for holding the cord. 



forceps it is difficult to compress the spermatic cord sufficiently, the 

 handles have since been much lengthened and the jaws shortened, 

 modifications which have greatly increased their efficiency. 



In torsion of the spermatic cord complete closure of the blood- 

 vessels is of prime importance. This can be secured by firmly com- 

 pressing the portion of cord grasped by the fixation forceps or clam, 



Fig. 234. — Robertson's forceps for torsion of the cord, 

 as adopted by Moller. 



and by slowly rotating the torsion forceps. The artery, reduced to 

 a fine thread, is the last portion to rupture, and only yields after 

 prolonged twisting. As a rule fifteen to twenty turns are necessary, 

 sometimes even more. When immediate bleeding occurs it may be 

 due to untwisting of the external coat of the vessel, to its rupture 

 ,above the twisted portion, or to the force of the blood overcoming 



