The =right adrenal= and =kidney= are removed in the same way, by
making a curved incision around the outer border of the organs,
pulling them up toward the median line and cutting the blood-vessels
from above downward against the spine, and then stripping the ureter
downward to the pelvis. After removal the adrenal is separated from
the kidney and examined as directed above for the left adrenal. The
kidney and ureter are then examined in the same way as on the left.
When it is desired to remove the right kidney with the pelvic organs
the same procedure is carried out as advised above in the case of the
left one. In the removal of the right adrenal care should be taken
not to injure the vena cava. In the case of displacement of either
kidney the incisions for the removal of the organ must be altered to
suit the case.
When the kidneys are removed before the examination of the
intestines and liver, the removal of the left adrenal and kidney
usually follows the examination of the spleen. The small intestines
are pulled over to the right; the peritoneum is incised over the
left kidney between the descending colon and the spinal column so
that the right hand can be worked beneath the peritoneum up above
the adrenal and kidney, freeing them, and lifting them toward
the median line. The vessels are then cut as directed above, and
the ureter stripped down to the pelvis. On the right side the
cæcum and ascending colon are raised and a cut made through the
peritoneum at the brim of the pelvis. The cæcum, ascending colon
and peritoneum are now stripped upward with the left hand until the
right hand can be passed up above the right adrenal to loosen it
and the kidney toward the median line. When this is accomplished
the adrenal and kidney are held in the left hand, while the right
cuts the blood-vessels from above downward against the spine,
sparing the ureter, which with the two organs is stripped downward
to the pelvic brim. The close proximity of the right adrenal to
the under surface of the liver makes the removal in this way much
more difficult than when the liver is removed first. Usually, when
the method of removing the kidney after the spleen is adopted, the
adrenal is left in the body until after the removal of the liver.
Public-domain text, read in full here on John Shaqi.
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