Modern surgery : General and operative / by John Chalmers Da Costa.

  • John Chalmers DaCosta
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: Modern surgery : General and operative / by John Chalmers Da Costa. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    water, or in some cases plug with iodoform gauze for twentj'- four hours. When hemorrhage ceases put a large drainage- tube down to the kidney. Close the wound in the muscles and integument and dress antiseptically. The dressings must be changed frequently and the tube should be shortened daily. Nephi'ectomy is the remo\aI of a kidney. There are two methods oi nephrectomy, the lumbar and the abdoviinal. Be- fore perlbrming nephrectom\- ascertain the competence of the kidneys. If at least i £er cent, of urea is not being excreted, it is ver}' unsafe to operate. Be sure the patient possesses two kidneys. Examination of the bladder by a cystoscope will show the ureteral orifices, a strong indication that both kid- neys are present. Nevertheless, when we reflect that a horseshoe kidney has two ureters the proof is not absolute. Catheterization of the ureters is advisable if it can be per- formed, but it will probably require a specialist to perform it. Proof absolute QiLllie_pi::es;ence of two kidneys consists inJ^elingrbbtlTof .them. If in doubt as to the question, and if uncertain as to the competence of the organ which is to be left, feel each kidney during the operation and before removing either, or perform a preliminar}- explorator}- laparotomy. Lumbar Nephrectomy.—The instruments required for this operation are scalpels, a blunt-pointed bistour}-, forceps as used in the preceding operation, a clamp, retractors, spatulae, blunt hooks, an aneur}-sm-needle, a pedicle-needle, a grooved director, stout silk, an Allis dissector, sharp spoons, and a Paquelin cauteiy. The patient is placed on the sound side and a pillow is placed under the loin. Sev- eral incisions ha\e been proposed. In many cases the / oblique incisj^ is first made to permit of exploration. This incision is begun half an inch below the last rib and by the edge of the erectqr^pinae muscle, and is carried downward and forward toward the iliac crest. In some cases a kidney can be removed through this cut. In other cases the cut must be enlarged. It can be enlarged by extending the cut downward. ]\Iorris enlarges it b}* adding to it a vertical -, incision, which begins one inch below the origin of the oblique cut. Konigls- incision for nephrectomy consists of a vertical cut by the edge of the erector spinae, carried almost to the iliac crest, from which point it is cur\'ed forward toward the umbilicus, and is carried to or even through the rectus muscle. After thorough exposure lift the kidney, and separate it from the peritoneum, if possible, with the 61