An assistant holding the director, with the handle somewhat inclined
towards the operator,[14] the external incision of the usual extent is
made with the knife, until the groove is opened, and the point of the
knife rests fairly in the director, which can be readily ascertained
by the sensation communicated; the point being kept steadily against
the groove, the operator with his left hand takes the handle of the
director, and lowers it till he brings the handle to the elevation
described in plate 3, keeping his right hand fixed; then with an easy,
simultaneous movement of both hands, the groove of the director and the
edge of the knife are to be turned obliquely towards the patient’s left
side; the knife having the proper bearing is now ready for the section
of the prostate; at this time the operator should look to the exact line
the director takes, in order to carry the knife safely and slowly along
the groove; which may now be done without any risk of the point slipping
out. The knife may then be either withdrawn along the director, or the
parts further dilated, according to the circumstances I have adverted to.
Having delivered his knife to the assistant, the operator takes the staff
in his right hand, and passing the fore finger of his left along the
director through the opening in the prostate, withdraws the director, and
exchanging it for the forceps, passes the latter upon his finger into the
cavity of the bladder.
In extracting the calculus, should the aperture in the prostate prove
too small, and a great degree of violence be required to make it pass
through the opening, it is advisable always to dilate with the knife,
rather than expose the patient to the inevitable danger consequent upon
laceration.
In the case, on which the operation was first performed, the instruments
in every respect answered my expectations. Not the slightest impediment
was experienced in getting quickly into the bladder. The stone, which was
large for a child of between four and five years old, is here delineated
to shew the free incision which the mere passing of the knife along the
director, and withdrawing it without dilating, will make. The stone was
readily extracted, and the boy recovered without the intervention of a
bad symptom.
The operation was performed in the presence of Mr. Travers, Mr. Green,
and Mr. Tyrrell, Surgeons to St. Thomas’s Hospital.