516 ABDOMEN 



mesenteric plexuses, and, below, branches which issue from it are pro- 

 longed downwards across the fronts of the common iliac arteries into the 

 hypogastric plexus. 



Plexus Spermaticus. Each spermatic plexus receives filaments from 

 the aortic plexus and from the renal plexus of the same side. It 

 accompanies the corresponding internal spermatic artery and gives branches 

 to the ureter as well as to the testicle. In the female the corresponding 

 plexus is called the ovarian plexus and accompanies the ovarian vessels. 



Plexus Mesentericus Inferior. The inferior mesenteric springs from 

 the aortic plexus. It accompanies the inferior mesenteric artery and gives 

 secondary offshoots along the branches of the artery. 



Removal of the Spleen, Pancreas, and Duodenum. The dissector 

 should now proceed to the removal of the spleen, the pancreas, and the 

 duodenum, which should be kept together and preserved so that they can 

 be replaced in position when the relations of the kidneys are being studied. 



Cut through ( I ) the splenic artery about three-quarters of an inch from 

 its origin from the coeliac trunk ; (2) the portal vein, about one inch 

 above the union of the superior, mesenteric, and splenic veins ; (3) 

 the superior mesenteric artery half an inch below its origin from the 

 aorta ; (4) the gastro-duodenal branch of the hepatic artery. Fix the 

 splenic vein to the posterior surface of the pancreas with a few stitches. 

 Pull the spleen over towards the right side and cut through the left layer 

 of the lieno-renal ligament which is still in position, then remove the 

 spleen, the pancreas, and the duodenum from the abdomen. 



Removal of the Liver. The general position and connections of the 

 liver have been considered, and the left lobe has been detached and laid 

 aside (see p. 444). The right lobe must now be separated from the parts 

 to which it is connected. Strip the peritoneum from the anterior surface 

 of the inferior vena cava, from the point where it was exposed by the 

 removal of the first part of the duodenum to the point where it disappears 

 into the fossa venae cavse on the posterior surface of the liver. Raise the 

 liver as much as possible and, to the right of the inferior vena cava, cut 

 through the layer of the peritoneum which is reflected from the lower part 

 of the posterior surface of the liver to the diaphragm. This layer is the 

 lower layer of the coronary ligament. At the base of the liver the lower 

 layer of the coronary ligament becomes continuous with the right triangular 

 ligament which must also be divided. After the right triangular ligament 

 is divided, pull the liver downwards as far as possible, and cut through the 

 falciform ligament which connects the anterior and superior surfaces of 

 the liver to the anterior abdominal wall and to the diaphragm. Divide 

 this ligament from before backwards, and note as its posterior extremity 

 is approached that its right lateral layer becomes continuous with the tipfer 

 layer of the coronary ligament which passes from the posterior border of the 

 upper surface of the liver to the diaphragm. Divide this layer from right 

 to left, and be careful not to injure the upper part of the abdominal portion 

 of the inferior vena cava, which lies immediately behind it a little to the 

 right of the line of attachment of the falciform ligament. Now, with the 

 right hand, pull the right lobe of the liver forwards and to the left, detach- 

 ing its posterior surface from the diaphragm, with the fingers of the left 

 hand, until the right border of the fossa for the inferior vena cava is 

 reached ; then separate the vena cava from the fossa, with the fingers, from 

 below upwards, until the large hepatic veins are reached as they pass out 

 of the upper part of the posterior surface of the liver into the anterior wall 

 of the inferior vena cava, immediately below the diaphragm. Divide 

 these veins carefully with the knife and remove the right lobe of the liver 

 from the abdomen. 



