File:Diseases of the kidneys, ureters and bladder, with special reference to the diseases of women (1922) (14579303339).jpg

Identifier: diseasesofkidney01kell (find matches)
Title: Diseases of the kidneys, ureters and bladder, with special reference to the diseases of women
Year: 1922 (1920s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943 Brödel, Max, 1870-1941 Burnam, Curtis Field, 1877-
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Publisher: New York, London : D. Appleton and company

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and XTI ribs at a distance of about 6-7 cm. from the posteriormiddle line and extended obliquely downward and outward, as shown in Figure173, until about 4-5 cm. from the iliac crest. The length of the skin incision INCISIONS TO EXPOSE KIDNEY AND URETER. 385 need not exceed 12cm., and for simplenephrorrlia.phy an in-cision of 8 cm. willoften afford sufficientroom. If the XII rib beshort so as to resem-ble the transverseprocess of a lumbarvertebra, the incisionhad best be begunjust over the tip ofthat rib. A glanceat Figure 173 willexplain that the rea-son for this sugges-tion is that, afterhaving determinedby this cutaneous in-cision the exact posi-tion of the XII rib,it will be less difficultto accurately mapout the limit of thepleura. The Kind of Oper-ation. —T h e natureof the operation,whether minor ormajor in character,determines to a greatextent the length anddirection of the in-cision. In every in-stance the skin in-cision ought to beginat the point abovelength that pictured
Text Appearing After Image:
Fig. 173.—Position and Length of Incision for All MinorOperations on Kidney. For example, suspension of kidney,nephrotomy, i>yelotoiny and simple nephrectomy. Note howincision is immediately over superior Imnbar trigonum. Theposture of patient on kidney bag is the ideal one. The bodylies on bag so that the side operated on is uppermost, and sostretched that the distance between the last rib and thecrest of the iUum is increased. described; in minor operations it need not exceed inin Figure 173, while in major operations it should be 386 SURGICAL OPERATIONS ON THE KIDNEY. considerably longer and curve more anteriorly, parallel to the lower ribs (Fig. 183). If the kidney is of ordinary size, and in its usual place, it is best approachedthrough the superior lumbar trigonum, while, if we have to deal with a kidney converted into a tumor mass extending far below the costal margin and project-ing for some distance laterally, the operator requires more room than allowedby the superior l

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