Circular Amputation of the Cervix 633 



lips. The tissues are injected at frequent intervals with a 

 local anaesthetic to which adrenalin chloride has been added. 

 A circular incision is now made around the margin of the 

 true cervical lips, as shown in Fig. 200. The vaginal mu- 

 cosa is seized at frequent intervals around its free margin 

 with artery forceps and, applying moderate traction, is care- 

 fully dissected from the underlying cervical body as far 

 forward as the endocervical mucosa is diseased. A longitu- 



Fig. 200a — Special Instruments for Trachelectomy. 

 /, Cervical retractor ; 2, Tenaculum forceps. 



dinal incision is now made through the core on either side, 

 dividing it, for the entire length of that portion which has 

 been freed from the vaginal mucosa, into about equal upper 

 and lower halves (See Fig. 201) . At this point in the opera- 

 tion, it should be ascertained that the cervical stump is 

 firmly grasped by the tenaculum forceps, because at a later 

 stage their replacement would become very difficult, should 

 their hold be lost. Each of the two segments of the cervical 

 core has an inner lining membrane of endocervical mucosa, 



