Exposure of the Kidneys.
—Richer1 advocates what he terms the topographic kidney incision, by means of which he is able to make an opening directly over the kidney, pelvis and upper ureter.The incision through the skin is vertical and within the border of the sacrolumbar muscular mass, 3 cm. from the spinous processes and extending from about the level of the twelfth rib, 6 or 8 cm. toward the posterior superior iliac spine. The fascia is cut and the muscle split. The aponeurosis of the transversalis muscle, which opens on a layer of connective tissue containing the roots of the ilio-inguinal and iliohypogastric nerve, is split. These should be preserved. The fatty capsule of the kidney is then seen, and when this is opened the kidney and its pedicle are disclosed.This incision is satisfactory for nephrotomy, for the removal of small kidneys, especially those lying close