(2) The abdominal wound is retracted, and the surrounding organs
protected with laparotomy pads, using instruments and sutures as for routine
(3) The retroperitoneal area near the diaphragm is opened on the left side,
exposing the renal fascia.
The renal fascia is opened to reveal the left kidney and adrenal gland.
(5) The adrenal gland is freed from the kidney by sharp and blunt
dissection, clamping and ligating all bleeding vessels with silk sutures number 3-0 or
(6) After all bleeding is controlled, the kidney is gently replaced in the renal
fascia, and closed with interrupted chromic sutures number O.
The peritoneum is closed over the left kidney and renal fascia.
(8) The abdominal retractors are rearranged to give access to the
peritoneum over the right kidney and adrenal gland. Care must be taken here to avoid
trauma to the liver.
The right retroperitoneal space is opened to reveal the renal fascia.
(10) The renal fascia is opened, exposing the right kidney and adrenal gland.
(11) The adrenal gland is freed in the same manner as the left one and
(12) The right kidney is replaced in the renal fascia, which is sutured closed.
(13) The right retroperitoneal area is closed with chromic sutures #0.
(14) The abdomen is inspected for bleeding vessels, which are ligated.
(15) The wound is closed in the routine laparotomy fashion.
Section IV. OPERATIONS ON THE BLADDER AND PROSTATE
3-22. OPEN OPERATIONS ON THE BLADDER
a. General. The urinary bladder may be opened to remedy acute retention;
relieve obstruction and distention; control hemorrhage; remove stones, tumors, or
foreign bodies; or repair congenital or traumatic defects. Other radical procedures are
performed to treat cancer. Total cystectomy requires permanent urinary diversion.