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General Surgery
Kidneys and Ureters
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
11 sections · 189 slides
Overview
- Scope of this topic
Embryogenesis of the kidneys and ureters
- The three excretory systems
- Mesonephros
- Derivatives of the ureteric bud
- Metanephros and nephron formation
- Ascent and rotation of the kidneys
- Cervical nephrotomes and the developing mesonephros
- Three sets of excretory systems in the fifth-week embryo
- Development of the mesonephric tubule
- Development of the ureteric bud and collecting system
- Medial rotation and ascent of the kidneys
Congenital anomalies of the kidney and ureter
- Renal agenesis
- Anomalies of rotation
- Ectopic kidney
- Horseshoe kidney
- Duplications of the urinary tract
- Ectopic ureteric orifice
- Weigert-Meyer rule and primary obstructive megaureter
- Classification of renal cystic disease
- Autosomal recessive polycystic kidney disease
- Autosomal dominant polycystic kidney disease
- Non-genetic cystic disease and fetal obstructive uropathy
- Anomalies of the urinary system
Surgical anatomy of the kidneys
- General topographic features of the kidney
- Dimensions and weight of the adult kidney
- Vertebral level and mobility of the kidneys
- Renal Size in Pediatric Patients Using Ultrasound Measurements
- Renal Size in Pediatric Patients Using Ultrasound Measurements (continued)
- Anterior relations of the kidneys
- Visceral contact areas on the anterior surface of the kidney
- Anterior relations of the kidneys to the abdominal organs
- Posterior relations of the kidneys
- Posterior relations of the kidney
- Areas of relation on the posterior surface of the kidney
- Relations of the kidneys to muscles, ribs and pleura
- Lateral border, medial border and the renal hilum
- Renal sinus, renal pelvis and calices
- Position of the renal pelvis relative to the vessels
- The renal fascia and its adrenal partition
- Relations of the upper pole and the adrenal gland
- The closed perirenal space
- Important posterior relationships of the kidney
- The hepatorenal recess of Morison
- Position of the kidneys and nephroptosis
- Dietl's crisis
Vascular supply of the kidneys
- Origin and course of the renal arteries
- Segmental division of the renal artery
- Segmental branches of the right renal artery on angiography
- Renal angiogram and diagram of the segmental branches
- Segmental circulation of the right kidney
- Intrarenal course of the apical, basilar and anterior segmental arteries
- Posterior segmental artery and the posterior calices
- Vascular segments of the left kidney
- Brodel's avascular line
- Anterior and posterior arterial territories in horizontal section
- The avascular plane of the kidney
- Multiple and accessory renal arteries
- Accessory renal arteries of the right and left kidneys
- Additional renal arteries: nomenclature and incidence
- Consequences of ligating an accessory renal artery
- Venous drainage of the kidneys
- Operative rules for the renal veins
- Venous collateral circulation of the left kidney
- Circumaortic renal collar
- Retroaortic left renal vein
- Additional left renal vein
- Plastinated left kidney showing type IB venous drainage
- Overview of the renal vasculature
Lymphatics, innervation and renal structure
- Renal lymphatic drainage
- Nodal drainage: right versus left kidney
- Regional lymphatic drainage of the right kidney
- Regional lymphatic drainage of the left kidney
- Innervation of the kidney
- Renal cortex and medulla
- The renal lobe and lobule
- Renal vasculature, nephron position and the cortico-medullary structure
- The nephron and the pathway of urine
- The nephron with a short loop of Henle
- Subdivisions of the Nephron and Collecting Duct System
- Subdivisions of the Nephron and Collecting Duct System (continued)
Surgery of the kidney
- Choice of incision in renal surgery
- Subcostal flank incision
- Flank incision at the 11th rib
- Flank incision extended to the anterior lateral abdominal wall
- Unilateral subcostal incision
- Bilateral subcostal chevron incision
- Extraperitoneal anterior incision
- Eleventh rib transperitoneal incision
- Midline upper abdominal incision
- Midline lower abdominal incision
- Long midline xiphoid to pubis incision
- Modified Gibson incision
- Thoracoabdominal incision
- Incision over the 12th rib in the posterior area
- Dorsal lumbotomy
- Trocar sites for laparoscopic nephrectomy
- Port placement for retroperitoneal laparoscopic nephrectomy
- Muscle layers of the posterolateral wall
- Superficial musculature of the anterior abdominal and thoracic walls
- External oblique, internal oblique and transversus abdominis
- Relationships of internal oblique, transversus abdominis and rectus abdominis
- Thoracolumbar fascia and the rectus sheath below the arcuate line
- Superficial and intermediate muscles of the posterior abdominal wall
- The diaphragm and posterior abdominal wall musculature
- Thoracic musculature deep to sacrospinalis and latissimus dorsi
- Cleavage planes of the posterolateral wall and retroperitoneum
- Structures of the outer muscle layer
- Structures in the middle layer
- Structures in the inner layer
- Attachment of the intercostal muscles
- Structures in the innermost layer
- The diaphragm
- Posterior approach through the thoracolumbar fascia
- Partial and paediatric partial nephrectomy
- Simple and radical nephrectomy
- Operative planes and hazards in radical nephrectomy
- Renal trauma
- Milestones in renal replacement and transplantation
- Surgical anatomy of the renal donor
Anatomic complications of renal surgery
- Organs injured during renal surgery
- Diaphragmatic injury
- Bleeding from adrenal injury
- Splenic and pancreatic injury
- Hepatic, duodenal and colonic injury
- Acute adrenal insufficiency after bilateral surgery
- Complications of renal transplantation
Surgical anatomy of the ureters
- General features of the ureter
- Abdominal course of the ureter
- Abdominal course of the ureter
- The intersigmoid fossa and the ureter
- Relation of the ductus deferens to the ureter
- Pelvic course of the ureter
- Pelvic relations of the ureter in the male: oblique view
- Pelvic relations of the ureter in the male: coronal view
- Pelvic relations of the ureter in the male: lateral view
- Ureteric relations in the female pelvis
- Anatomic landmarks of the ureter in the female pelvis
- Mean Distances from the Ureter and from the Arcus Tendineus to the Pelvic Floor
- The three anatomic narrowings of the ureter
- Variations in ureteric calibre and the three narrowings
- The ureterovesical junction and intravesical ureter
- Layers of the ureteric wall
- The ureteric wall
- Arterial supply of the ureter
- Sources of ureteric arterial supply
- Segmental blood supply and safe division of the ureter
- Practical rules for handling the ureter
- Blood supply of the ureter
- Sources of ureteric arterial supply with percentages
- Venous and lymphatic drainage of the ureter
- Lymphatics of the ureter
- Management of ureteric tumours
- Innervation and referred pain from the ureter
- Referred somatic pain from the upper urinary tract
- Ureteric peristalsis and the ureterorenal reflex
Surgery of the ureter
- Surgical division of the ureter into thirds
- Approaches to the upper and middle ureteric segments
- Approaches to the lower ureteric segment
- Pfannenstiel incision and the iliohypogastric nerve
- Courses of the iliohypogastric and ilioinguinal nerves
- Ureteric reconstruction
- Categorization of the Usual Length of Ureteral Defect That Can Be Bridged with Various Surgical Techniques for Ureteral Reconstruction
- Anatomic complications of ureteric surgery
- Recognising and repairing ureteric injury
- Late sequelae and Wharton's common errors
- Common sites of ureteric injury in gynecologic surgery
History, summary and sources
- Anatomic and Surgical History of the Kidney and Ureter
- Anatomic and Surgical History of the Kidney and Ureter (continued)
- Anatomic and Surgical History of the Kidney and Ureter (continued)
- Anatomic and Surgical History of the Kidney and Ureter (continued)
- Anatomic and Surgical History of the Kidney and Ureter (continued)
- Anatomic and Surgical History of the Kidney and Ureter (continued)
- Take-home points: kidney
- Take-home points: ureter
- Sources cited in this chapter
- Sources cited in this chapter (continued)
- Sources cited in this chapter (continued)
- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
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