. Manual of operative surgery. in). Whenever the needle touches a calculus, a sensation of gratingis communicated to the hand. Should a cyst of the kidney be discovered, itscontents may be obtained for examination by means of the exploring needleand syringe. KIDNEY 647 The above exploration of Ihe kidney often fails to give the informationdesired, and further investigation is necessary. Exploration of the Renal Pelvis without Pyelotomy. Delbets Method.—Expose the kidney through the lumbar route, deliver it on to the back and placeit so that its posterior surface is exposed to view
. Manual of operative surgery. in). Whenever the needle touches a calculus, a sensation of gratingis communicated to the hand. Should a cyst of the kidney be discovered, itscontents may be obtained for examination by means of the exploring needleand syringe. KIDNEY 647 The above exploration of Ihe kidney often fails to give the informationdesired, and further investigation is necessary. Exploration of the Renal Pelvis without Pyelotomy. Delbets Method.—Expose the kidney through the lumbar route, deliver it on to the back and placeit so that its posterior surface is exposed to view and touch. Beginning at itsureteral end, free the posterior surface of the renal pelvis from its covering ofloose fatty areolar tissue by blunt dissection. Push aside the areolar tissue andretract it, very gently, along with the blood-vessels and the parenchyma formingthe wall of the sinus. The same dissection may be made, if necessary, on theanterior surface of the pelvis. By this means most of the pelvis, often all of Fig. 792.—{Ddbct and Mocqnot.) and sometimes the beginning of the primary tubes may be exposed to view. Itis now possible to pass the finger into the sinus behind the pelvis without tearinganything and thus directly palpate the pelvis. The finger can be introduced inthe middle transverse diameter of the kidney to the bottom of the sinus and canpalpate the middle calices; towards the upper and lower poles it cannot beintroduced so far, but it can always explore a considerable portion of the upperand lower primary tubes. Delbets method permits useful accurate palpation without danger; theordinary methods of palpation unaccompanied by the dissection described areclumsy and only calculated to reveal gross lesions. Nephrotomy.—Step i.—Expose and isolate the kidney as in the operation ofexploration. 648 OPERATIONS UPON THE KmNEY KIDNEY Step 2.—Deliver the kidney on to the patients back. Surround the hilus orpedicle with a rather fine rubber band or tub
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