The left =adrenal= and =kidney= are now examined. If the pancreas
and stomach have not been removed from the body they are turned over
toward the thoracic cavity, so as to expose completely the left
adrenal. The movability of the kidney is then tested. Beginning
above the adrenal an incision is made through the peritoneum and
underlying tissue, curving outward around the kidney and downward to
its lower pole, taking care not to bring the incision too far around
the lower pole of the organ for fear of cutting the ureter. The knife
is then laid aside, and the adrenal and kidney are pulled upward
toward the median line until they are entirely free save for the
blood-vessels and ureter. The loose tissue about the fatty capsule
of the kidney is usually easily separated. The blood-vessels are
then cut from above downward against the spinal column, the ureter
being left uncut. Holding the kidney in the two hands, it is pulled
downward toward the pelvis, stripping the ureter free as far as
the pelvic brim. At this level the ureter may be cut, or, if it is
desired to remove the kidneys in connection with the pelvic organs,
the ureter is left uncut and the kidney laid over the pubis until the
pelvic organs are removed. When the kidney and adrenal are removed
they are placed upon the board and the adrenal separated. The latter
organ is then examined by means of parallel transverse incisions, or
by an incision in its longest axis in the middle of its flat surface.
When the adrenal is left in the body it may be examined by means
of the same incisions. The fatty capsule is then stripped from the
kidney and the organ weighed and measured. It is then held in the
palm of the left hand with the ureter between the middle fingers, the
convex border up, the thumb placed on one flat surface, the fingers
on the other, holding the organ tightly. The kidney is then opened by
means of a long incision made with the long section-knife, beginning
at the upper pole, drawing the knife through the convexity, to the
lower pole, and extending the cut through the organ to the pelvis.
As the knife approaches the hilus the grasp of the left hand upon
the organ is loosened and pressure upon the knife lessened so as not
to cut through the hilus. The edges of the fibrous capsule are then
caught by the fingers or forceps and the capsule stripped from the
cortical surfaces. The external surface and the cut surfaces are then
examined. When indicated other incisions into the kidney substance
may be made. The ureter is sounded from the pelvis, and opened with
the fine probe-pointed shears. The renal artery and vein may be
examined now, or better when the kidney is being removed.
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