Gynecology . \ h / \ \ / 1 . \ X Fig. 395.—Suspension of latissimus dorsi has been cut transversely. The retroperitoneal fat has been opened and theperirenal fat grasped with forceps. Traction of the perirenal fat has brought the upper pole of thekidney into view (adapted from Kelly and Burnam). the movable kidney is forced upward under the ribs, so that in bringing it intoview it must be drawn downward rather than upward. The kidney is brought OPERATIONS ON THE KIDNEY 689 into view by attaching several clamps to the fatty capsule and exerting carefultraction so as not to tear the f
Gynecology . \ h / \ \ / 1 . \ X Fig. 395.—Suspension of latissimus dorsi has been cut transversely. The retroperitoneal fat has been opened and theperirenal fat grasped with forceps. Traction of the perirenal fat has brought the upper pole of thekidney into view (adapted from Kelly and Burnam). the movable kidney is forced upward under the ribs, so that in bringing it intoview it must be drawn downward rather than upward. The kidney is brought OPERATIONS ON THE KIDNEY 689 into view by attaching several clamps to the fatty capsule and exerting carefultraction so as not to tear the fat. In order to expose a space for the insertionof stitches the capsule is stripped from the posterior surface and upper pole ofthe kidney. The kidney, without being delivered, is then thoroughly palpated to discoverany incidental q(Ux JpTooev Fig. 396.—Suspension of of the Brodel suture (adapted from Kelly and Burnam). In placing the stitches for suspension the object in view is to create an arti-ficial adhesion between the capsule of the kidney and the muscle with which itis to lie in contact. This can best be accomplished with a non-absorbable stitch,either of linen or silk, preferably the latter. As to the level at which the kidney should be suspended, Kelly advocates 44 690 GYNECOLOGY attaching it as high as possible, and our experience substantiates this the kidney can be made to recede above the twelfth rib the external obliquemuscle is strongly retracted or, if necessary, cut, and the tissues dissectedback until the twelfth rib is exposed. Three stitches of fine silk are to be used for suspending the kidney. Theyare placed in a line along the outer border of the kidney, the upper one at the Stitches
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