. Manual of operative surgery. incision parallel to and i inch above Pouparts ligament, as far asits centre (Figs. 816 and 817). Cut down to, hut not through, the peritoneum. 666 OPERATIONS OX THE URETER Expose the kidney. Palpate the renal pelvis between finger and thumb. Byexercising slight traction on the pelvis the ureter may be made more the fingers or a pledget of gauze strip the peritoneum from theparietesuntil the ureter is seen. The relation of the ureter to that part of the peri-toneum which is adherent to the spine is rather constant, the ureter being situ-ated just e
. Manual of operative surgery. incision parallel to and i inch above Pouparts ligament, as far asits centre (Figs. 816 and 817). Cut down to, hut not through, the peritoneum. 666 OPERATIONS OX THE URETER Expose the kidney. Palpate the renal pelvis between finger and thumb. Byexercising slight traction on the pelvis the ureter may be made more the fingers or a pledget of gauze strip the peritoneum from theparietesuntil the ureter is seen. The relation of the ureter to that part of the peri-toneum which is adherent to the spine is rather constant, the ureter being situ-ated just external to the line of adhesion. Therefore, when the operator hasstripped up the peritoneum and reached this point, he will find the ureter on thestripped-up peritoneum external to it. (Kelly.) Remember that the ureteradheres to the peritoneum even when that membrane is raised from the sub-jacent structures. A little tension exercised on the renal pelvis helps to renderthe ureter recognizable. UIOINCUINAl N tPIOASlRll. A. IIG. Si8.—(Hcrrick, Cleveland Med. Jour.) (b) Exploration of pelvic portion of ureter. Roll the patient over so thatwhile still resting on his sound side his back, instead of his abdomen, is turnedsomewhat towards the table. Enlarge the wound, if necessary, forwards,even as far as the external abdominal ring (Morris), always carefully avoidingopening the peritoneum. This huge wound may be avoided by seeking thepelvic ureter through a low gridiron incision which penetrates to, but notthrough, the peritoneum. Should the peritoneum be opened by accident, closeit at once with sutures. Sometimes the kidney is not available as a guide to theureter and one is forced to hunt for that tube at the pelvic brim. Here the guideto the ureter is the place where it crosses the iliac artery, and when the peri-toneum is stripped off, it will be found adhering to that membrane like awhitish or yellowish-white tape. In the male the ureter may be examined in EXPOSURE URETE
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