58 SPRINGTIME SURGERY 



enlargement of the opening is necessary make it 

 upward and backward ; never by use of the knife 

 or other means enlarge the opening in the other 

 directions. If one finds a testicle so large that 

 it cannot be forced out through this area with- 

 out endangering this band of fibers, then it is too 

 large a testicle to be removed through the in- 

 guinal region. This is too dependent a portion of 

 the belly wall for large openings at any point. 

 My method of handling such cases, which fortu- 

 nately are very rare, is, if the testicle cannot be 

 forced through the opening after all means of 

 reducing its size (tapping of cysts, etc.) have 

 failed, to discontinue the operation at this point, 

 allow the inguinal wound to heal, and after three 

 or four weeks remove the testicle through a lapa- 

 rotomy in the upper flank region. 



Locating the Testicle.— We will presume 

 that the operator has traversed the inguinal canal, 

 located the internal ring area, and advanced be- 

 yond this area in a direction upward and backward 

 until he finds his fingers against the pelvic inlet 

 at the middle of the shaft of the ilium, and at this 

 point has thrust two fingers through the medium 



