Fig- ^34- Right Kidney, exposed from behind. 



Oil the right side of a male corpse a window-section has been ^ade by removing 

 skin, part of the Latissinms Dorsi, two digitations of the Serrattts Posticus 

 Inferior, the tendinous origin of the Transversalis Muscle and the fatty tissue 



behind the Kidney. 

 The Kidney is tilted forward to exhibit the hihini. 



The Left Kidne\' extends from the upper border of the 1 2th Dorsal 

 ^'ertebra to the lower border of the 2nd or to the middle of the 3rd Lumbar 

 ^'ertebra. The Right Kidney is usually about the space of Y2 ^ vertebra lower. 

 The upper half of the Kidne\'s lie ver\' near the pleural cavities from which they 

 are only separated b}' the Diaphragm. 



The distance from the lower end of the Kidney to the crest of the Ilium 

 varies considerably (iV.i^h inch in the male, i inch in the female, on the right 

 side; rYsths inch in the male and iVr.th inch in the female on the left side). 



Access to the kidney is obtained by two routes, either from in front (trans- 

 peritoneally — cf. Fig. 135, text) or from behind (from the Lumbar region). B3' 

 the latter route the surgeon has the ad\antage that in operations upon the kidney 

 the peritoneum is not opened. The route followed is at the border of the Sacro- 

 Spinalis Muscle after division of the lower border of the Latissimus Dorsi, the 

 deep laj'er of the lumbar fascia is then divided. After division of the Fascia 

 TransversaUs and the Renal Fat the lower end of the Viscus is exposed. In 

 extending the incision upwards as far as the 1 2th rib the Pleura ma}' be slighth' 

 injured, as its line of reflection runs from the lower border of the 12th Dorsal 

 \'ertebra in a horizontal direction outwards across the 12th rib if this bone be 

 of some length; in this case the anterior part of the rib lies below the pleura. 

 If the bone is \&cy short the i ith rib may easilj^ be mistaken and thus an incision 

 carried forward may open into the pleura. 



For operations near the Pelvis of the Kidney the situation of the Arter>' 

 and Vein anteriorly affords a great advantage in rendering the Pelvis easily 

 accessible from behind ; the same advantage applies to the upper part of 

 the Ureter. 



The lower part of the Ureter is reached b}' "an Oblique lateral incision" 

 as for ligature of the Common Iliac Arterw This incision is carried from the 

 upper border of the 1 2th rib obliquely downwards and forwards to the junction 

 of the outer and middle third of P< >UPART's ligament. The peritoneum is pushed 

 aside without opening. The lowest part of the Ureter below where it crosses 

 the Common Iliac Artery can also be reached extra-peritoneally b\' an incision 

 made parallel with and directly abo\e Poupart's ligament. 



