 Okay, so this is a quick demonstration of the right kidney in situ. So let's take a look at this fascia here. This is the fascia transversalis which is coming out of the posterior and this is the one which is splitting to form the anterior layer of the renal fascia or the gerotas fascia and we have removed it. Under that we can see a layer of fat. This is the perinephric fat. The perinephric fat covers the kidney from the front and we can see some more of the fat here below and the perinephric fat also goes behind the kidney and we can show it here. You can see the perinephric fat is behind also. The same fascia, anterior layer of renal fascia, there's a posterior layer of renal fascia and behind that will be another fat which is called the pararenal fat. But that we cannot see now. In the lower part, the renal fascia is not fused with each other. The anterior and the posterior layers are separate. Why? Because it is filled by this perinephric fat and this has got an important clinical significance. When a person undergoes rapid weight reduction and fat loss, this fat is not there to support the kidney anymore and the kidney descends down and that is called nephroptosis. So that is about the fascia covering. Now let's take a look at the kidney itself, the right kidney. Straight away we can see that on the superior pole of the kidney there is this organ here. It is also enclosed in the same fascia, the supra renal fascia but there is a septum which clearly separates the supra renal gland from the upper pole of the kidney and my finger is running along the septum. So this is the septum which separates the supra renal gland from the kidney and the supra renal fascia in turn is adherent to the under surface of the diaphragm. So this also has got a clinical significance. Then if the kidney descends down, as I mentioned called nephroptosis, the supra renal gland does not descend down. It remains stuck to the under surface of the diaphragm. So this is also an important point to be remembered. Now let's take a look at the parts of the kidney. This is the superior pole of the kidney where my finger is located. This is the inferior pole and we can see that there is a slight lobulation of the surface which is the persistence of the fetal lobulation. This is the anterior surface and this is the posterior surface. Take a look at the orientation of the kidney. The kidney is not exactly horizontal. It is slightly oblique. So therefore the medial border is anterior medial and the lateral border is postural lateral. And this also has a clinical significance. When a patient is lying bedridden for many months and years, urine tends to collect in the renal pelvic acetyl system and that can produce a calculus which is known as a staghorn calculus. So anterior surface, posterior surface, medial border, lateral border, inferior pole, superior pole. These are the parts of the kidney. This region, this is called the renal hyalum and these structures which are entering and leaving the renal hyalum, they enter into a space between the anterior and the posterior surface of the kidney and that space is called the renal sinus. And the renal sinus contains the renal vessels, the pelvic acetyl system and it also contains the perinephric fat which extends in. Now let me show you the renal vessels. Take a look at this structure here. This is the abdominal aorta. And this is to the left and this is the inferior vena cava which is to the right. So we have the renal vessels coming straight from the abdominal aorta and renal vein draining straight into the inferior vena cava. The renal artery is posterior because it is thick wall and the vein is anterior. So what we can see on the right renal kidney is this structure anteriorly. This is the right renal vein. You can see the left renal vein here and straight away we can see that the left renal vein is much longer than the right renal vein. The right renal vein is located anterior in both the sides. The left renal vein is also anterior but the left renal vein receives this vein here. This is the gonadal vein on the left side. In this case it's a male so it's a testicular vein. If it's a female it will be ovarian vein. And this vein also is draining into the left renal vein. This is the left supra renal vein. We notice that the left renal vein is running anterior to the aorta for the same reason so that it does not get compressed. The left renal vein can be used as anastomosis for the splinic vein to form what is known as a splino renal anastomosis. And here we can see this is the splinic vein. And the splinic vein is located very close to the left renal vein so we can use this to form an anastomosis. That is called a splino renal anastomosis which is used in cirrhosis with portal hypertension. We also notice that the left renal vein is running under this artery here. This is the supramacentric artery. So the left renal vein can get compressed between the supramacentric artery and the aorta where my instrument is located. And that is known as the left renal vein entrapment syndrome also known as the nutcracker syndrome. So we have seen some important clinical correlations pertaining to the left renal vein. The right renal vein does not have any of those problems because it is smaller than the left renal vein. In contrast, the renal artery on the right side is longer because the aorta is on the left and the artery runs behind. So we cannot see the artery here but we will be able to see it when I reflect out the inferior vena cava. Let's take a look at the structures, branches which are passing through the high limb. One I have already mentioned this is the renal vein. In this case it's the right renal vein. We can see some structures behind, one here, one here, one here. These are the segmental branches of the right renal artery. This is the right renal artery which is behind the right renal vein. The renal artery as it comes it divides into five branches, a superior and inferior anterior superior segmental, anterior inferior segmental and posterior segmental. So we can see three of those segmental branches right now. We can see one segmental branch here, we can see another segmental branch here, we can see another segmental branch here and more will be visible once we have dissected out the renal high limb. And in this dissection, we can also see the third structure coming out from the renal high limb and that is this. This is the right ureter. The point to be remembered about the right ureter is that as the ureter descends down, it has got a covering of fascia around it and that is called the periuretic fascia which is a derivative of the renal fascia itself. But more important if you look very closely, you will find that it has got a plexus of blood vessels on its surface and we can see the plexus of blood vessels and we can also see some blood vessels are supplying the ureter. This periuretic fascia is very important because all the blood vessels run on the periuretic fascia. So during surgery, we should not remove the periuretic fascia. If we remove the periuretic fascia, we will produce abascular necrosis of the ureter and that will lead to leakage of uren postoperatively. So that is about the ureter. So we have cut open the left kidney. Actually my assistant has done a wonderful job of cutting it open. So we made an incision along the lateral margin and we absolutely did it open. So what do we see? The outer rim is a thin rim of renal capsule which I have lifted up here and you can see this is the renal capsule. Just after that, this pale portion that we see here on either side, that is the renal cortex and after that everything else inside is the medulla and finally this innermost portion that we see here is the pelvic helicine system. So we have basically three parts, the renal cortex, the medulla, pelvic helicine system. The cortex is the place where we have all the convoluted tubules, the glomerulus, the woman's capsule, etc. Coming to the medulla, we see pigmented areas. These pigmented areas are referred to as the renal pyramids or the medullary rays and if you look very closely, you see that they have a striated appearance and they have a striated appearance. This is where the collecting ducts converge, the collecting ducts of Bellini and in between two adjacent pyramids we have this white portion here. This is the renal columns of Bertini and this is through here that the blood vessels enter into the kidney substance because the blood vessels are coming from the renal hyalum. At the apex of the renal pyramids, we have this convex projections. These are referred to as the renal papilla and they communicate with the concave minor calyx and that is where the filtration of urine takes place. One renal pyramid with half of the adjacent renal column, this constitutes what is known as a renal lobe and that is how the urine drains. From the minor calyx, it drains into the major calyx and from the major calyx it drains into the pelvis and from the pelvis it drains into the ureter and that is how it drains into the pelvic calyx system. So this is what we see in the cut section of the kidney. So this is all the structures which I wanted to show you in the kidney and all the associated facial relationships and the vessels. Thank you for watching. Dr. Sanjay Sanyal.