Abstract
Nephrectomy was performed experimentally on healthy dogs and goats, totaling 22 There are two methods for nephrectomy. One is carried out extraperitoneally and the other through the peritoneum. The purpose of operation will decide which method is to be adopted in a particular case. In general, the latter seems to be advantageous.
The animal is laid down on the operating table with its side to be operated up. A pillow is inserted under its loin so that the kidney may easily be exposed during operation. Disinfection and anesthesia are conducted as usual. An incision 7 to 12 cm in length is made on the skin near the posterior border of the last rib and the inferior border of the musculus quadratus lumborum and obliquely toward the inferior part of the crest of the ilium. Then the abdominal muscles and the peritoneum are incised to enable the operator's hand enter the abdominal cavity to search for the kidney. The peritoneum covering the anterior surface of the kidney is broken and the adipose tissue enveloping the organ teased by his fingers. When the kidney becomes free in the broken tissue, it is made to slide out into the peritoneal cavity with its stalk protected by two fingers of the operator from breaking. The renal artery and vein and the ureter are separated individually, ligated at two sites, and cut off between the sites. After the kidney is removed, the incised area is closed as usual.
As contamination is very little in this surgical operation, any after-treatment is scarcely needed until the wound is healed.
An important point in this operation is to take scrupulous care not to break blood vessels in the teasing of the adipose capsules, removal of the kidney into the abdominal cavity, and separation of the renal vessels and ureter. When a large amount of internal hemorrhage occurs by cutting a vessel, the opening of the incision on the abdominal wall is enlarge quickly so that the operator's hand may be inserted in the abdominal cavity and may press the abdominal aorta against the vertebra. At the same time the bleeding is checked temporarily by Pean's forceps. The blood is wiped away from inside the abdominal cavity. Then, by loosening Pean's forceps slightly, sites of hemorrhage are detected. The cut end of the renal artery which has been found is ligated firmly and the hemorrhage is successfully checked.
