330 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



Operations on the kidney. (1) Nephrotomy. 

 Incision into the kidney for exploration, or the 

 evacuation of pus. (2) Nephro-litkotomy. Incision 

 into the gland for the removal of a calculus. (3) 

 Nephrectomy. Removal of the entire organ. (4) 

 Nephroraphy. The operation of securing a movable 

 kidney in its normal position. In the first, second, and 

 fourth operations, the kidney is reached through the 

 loin by a transverse incision, such as is used in colotomy 

 (page 315). In nephrectomy a like incision may be 

 used, or, if more room be required, an oblique cut is 

 made running downwards and forwards from the middle 

 of the last rib. The capsule is incised and peeled off, 

 the gland being removed from within its capsule. In 

 some instances the last rib has been resected to obtain 

 more space for the operation. This can be done 

 without risk to the pleura. In one case the twelfth 

 rib was rudimentary, and the eleventh rib was re- 

 moved under the impression that it was the twelfth. 

 The pleura was opened and death ensued. When the 

 kidney is free from its capsule, the structures at the 

 hilus are secured en masse by a ligature. In removing 

 large renal growths an abdominal incision is advised, 

 the cut being made along the corresponding semilunar 

 line, and on a level with the diseased mass. The 

 abdominal operation of course involves an opening 

 into the peritoneal cavity, but it has the advantages of 

 greater ease and rapidity in performance. 



The ureters are strong tubes about fifteen inches 

 long, with thick muscular walls, and are placed entirely 

 behind the peritoneum. ' The average width is that 

 of a goose-quill. The narrowest part of the tube is 

 the portion within the bladder walls, and when renal 

 calculi pass along the ureter they are often arrested 

 at this point. The ureters permit of great distension, 

 and in certain cases of gradual dilatation they have 

 attained a width equal to that of the thumb and even 



