Gynecology Instruments

NCI Issues Clinical Announcement for Preferred Method of Treatment for Advanced Ovarian Cancer

harry — Thu, 08 Nov 2007 07:37:57 +0000

The two ways of applying anticancer drugs subsequent to surgical operations of women suffering from progressive ovarian cancer have been announced by the National Cancer Institute or NCI, which is sector of the National Institutes of Health or NIH. The joint techniques that transmit drugs into a vein and straightly into the abdomen lengthen the total survival of women with progressive ovarian cancer by approximately one year.
The two treatment techniques are known as intravenou (IV) that is for chemotherapy transported into a vein and intraperitoneal (IP) that is for chemotherapy transported into the abdominal or peritoneal cavity. The testing included four hundred twenty nine women with stage III ovarian cancer who received chemotherapy after the successful removal of tumors by means of surgery. The study contrasted two treatment procedures such as IV paclitaxel followed by IV cisplatin and IV paclitaxel followed by IP cisplatin as well as the succeeding administration of IP paclitaxel.
The National Cancer Institute wants to ascertain that the outcomes of clinical research are quickly circulated to both health care givers and patients to makes sure that life-enhancing cancer therapies are extensively accessible.
IP treatment is not a novel therapy strategy however it has not been generally acknowledged as the gold criterion for women with ovarian cancer. There has been a bias contrary to IP treatment in ovarian cancer due to an old notion, it needs knowledge and expertise for the surgery and for the chemotherapy and it is more complex than IV chemotherapy. Nevertheless the researchers have definite information and knowledge revealing that the doctors should utilize a mixture of IP and IV chemotherapy in majority of women with progressive ovarian cancer that have had successful surgical operation to take out the mass of their tumor.
Common therapy for women having stage III ovarian cancer has been surgical removal of the tumor to be trailed by six to eight programs of IV chemotherapy infused for every three weeks with a platinum drug like cisplatin or carboplatin, and a taxane drug like paclitaxel. The novel NCI clinical statement advocates that women with progressive ovarian cancer who endure successful surgical removal of tumor be given a mixture of IV and IP chemotherapy. IP chemotherapy permits higher doses and extra often giving out of drugs and it seems to be more effectual in annihilating the cancer cells in the peritoneal cavity in which ovarian cancer is expected to proliferate or reappear first.
In the trial women who were given portion of their chemotherapy by means of an IP route had an average survival time of sixteen months longer than women who were given only IV chemotherapy. The women medicated by means of the IP route coped better even though majority of them were given less than the six intended treatments. Problems connected with the abdominal catheter that were utilized to transport the IP chemotherapy were the chief reason that less number of women finished the entire six IP therapies. Women who were administered with IP chemotherapy had more offshoots as compared to those administered with IV chemotherapy only nonetheless majority of the offshoots were transient and simply managed. A year subsequent to the treatment, women in the two study groups had the identical reported quality of life.Continue research on this page

Vulvovaginal Candidiasis

gynecologyinstruments — Sun, 08 Jul 2007 10:13:22 +0000

An estimated 75 percent of women will have at least one episode of VVC, and 40 percent to 45 percent will have two or more episodes. A small percentage of women experience recurrent VVC or RVVC. Typical symptoms of VVC include pruritus and vaginal discharge. Other symptoms may include vaginal soreness, vulvar burning, dyspareunia, and external dysuria. None of these symptoms is specific for VVC.
Candida vaginitis can be diagnosed with suggested clinically by pruritus and erythema in the vulvovaginal area and white discharge may occur. The diagnosis can be made in a woman, who has signs and symptoms of vaginitis, and when either a wet preparation or Gram stain of vaginal discharge demonstrates yeasts or pseudohyphae, a culture or other test yields a positive result for a yeast species. Candida vaginitis is associated with a normal vaginal pH or less than or equal to 4.5. Use of 10 percent KOH in wet preparations improves the visualization of yeast and mycelia by disrupting cellular material that might obscure the yeast or pseudohyphae. To identify Candida by culture in the absence of symptoms should not lead to treatment, because approximately 10 percent to 20 percent of women usually harbor Candida sp. and other yeasts in the vagina. VVC can arise concomitantly with STDs or frequently following antibacterial vaginal or systemic therapy.

The topically applied azole drugs are more effective than nystatin. Treatment with azoles results in relief of symptoms and negative cultures among 80 percent to 90 percent of patients who complete therapy. Thus, topical formulations effectively treat VVC.
Preparations for intravaginal administration of butaconazole, clotrimazole, miconazole, and tioconazole are available OTC, and women with VVC can choose one of those preparations. The length for treatment with these preparations may be 1, 3, or 7 days. Self medication with OTC preparations should be advised only for women who have been diagnosed previously with VVC and who have a recurrence of the same symptoms. Any woman whose symptoms persist after using an OTC preparation or who has a recurrence of symptoms within 2 months should look for medical care.
A latest classification of VVC may help or facilitate antifungal selection as well as duration of therapy. Uncomplicated VVC, like mild to moderate, sporadic, nonrecurrent disease in a normal host with normally susceptible C. albicans responds to all the aforementioned azoles, even those that are short term or less than seven days, and single-dose therapies. In contrast, complicated VVC, like severe local or recurrent VVC in an abnormal host requires a longer duration of therapy, like ten days to two weeks with either topical or oral azoles. Additional studies confirming this approach are in progress.

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http://wonder.cdc.gov/wonder/STD/STD98TG/STD98T10.HTM

Trichomoniasis

gynecologyinstruments — Sun, 08 Jul 2007 10:10:22 +0000

Trichomoniasis is caused by the protozoan T. vaginalis, which could be simply identified under the microscope of smear of discharges. Most men who are infected with T. vaginalis do not have symptoms of infection, even though a minority of men has NGU. Many women, on the other hand, do have symptoms of infection. Of these women, T. vaginalis characteristically causes a diffuse, malodorous, yellow-green discharge with vulvar irritation and many women have fewer symptoms. Premature rupture of the membranes and preterm delivery might be associated with adverse pregnancy outcomes of vaginal trichomoniasis.
Sex partners should be treated. Patients should be instructed to avoid sex until they and their sex partners are cured. In the absence of a microbiologic test of cure, this means when therapy has been completed and patient and partners are asymptomatic.
The only oral medication available in the United States for the treatment of trichomoniasis is the metronidazole. In randomized clinical trials, the recommended metronidazole regimens have resulted in cure rates of approximately 90 percent to 95 percent and ensuring treatment of sex partners might increase the cure rate. Treatment of patients and sex partners results in relief of symptoms, microbiologic cure, and reduction of transmission. Metronidazole gel is approved for treatment of BV, but, like other topically applied antimicrobials that are unlikely to achieve therapeutic levels in the urethra or perivaginal glands, it is considerably less efficacious for treatment of trichomoniasis than oral preparations of metronidazole and is not recommended for use. Several other topically applied antimicrobials have been used for treatment of trichomoniasis, but it is unlikely that these preparations will have greater effectiveness than metronidazole gel.
Infections with strains of T. vaginalis that have diminished susceptibility to metronidazole can occur. However, most of these organisms respond to higher doses of metronidazole. If treatment failure occurs with either regimen, the patient should be re-cured with metronidazole 500 mg twice a day for 7 days. If treatment failure occurs repeatedly, the patient should be treated with a single 2g dose of metronidazole once a day for 3 to 5 days. Follow up is unnecessary for men and women who become asymptomatic after treatment or who are initially asymptomatic.
Effective alternatives to therapy with metronidazole are not available. Patients who are allergic to metronidazole can be managed by desensitization.
Patients with culture-documented infection who do not respond to the regimens described in this report and in whom reinfection has been excluded should be managed in consultation with an expert. Consultation is available from CDC. Appraisal of such cases should include determination of the susceptibility of T. vaginalis to metronidazole.
It is important to know that patients who have trichomoniasis and also are infected with HIV should receive the same treatment regimen as those who are HIV-negative.

Original text here:

http://wonder.cdc.gov/wonder/STD/STD98TG/STD98T10.HTM

Ovarian Cancer

gynecologyinstruments — Sun, 08 Jul 2007 09:31:45 +0000

Ovarian epithelial cancer is a disease in which malignant or cancer cells, which can be examined under the microscope by a pathologist, form in the tissue covering the ovary. The ovaries are a pair of organs in the female reproductive system that are located in the pelvis, one on each side of the uterus or the hollow, pear shaped organ where a fetus grows. The ovaries produce eggs and female hormones or chemicals that control the way certain cells or organs function.

Family histories of ovarian cancer among women are at an increased risk of developing ovarian cancer. Women who have one first degree relative like mother, daughter, or sister, with ovarian cancer are at an increased risk of developing ovarian cancer. This risk is higher in women who have one first degree relative and one-second degree relative like grandmother or aunt, with ovarian cancer. In women the risk is higher who have two or more first-degree relatives with ovarian cancer.

Some ovarian cancers are caused by inherited gene mutations or changes. The genes in cells carry the hereditary information that is received from a person’s parents. Hereditary ovarian cancer makes up approximately 5 percent to 10 percent of all cases of ovarian cancer. Three hereditary patterns have been identified are ovarian cancer alone, ovarian and breast cancers, and ovarian and colon cancers.

Genetic tests that can detect altered genes have been developed. These tests are sometimes done for members of families with a high risk of cancer. Women with an increased risk of ovarian cancer may consider surgery to prevent it. Some women who have an increased risk of ovarian cancer may prefer to have a prophylactic removal of healthy ovaries called ophorectomy so that cancer cannot grow in them. This procedure however is not known if it prevents ovarian cancer.

Ovarian cancer is hard to detect or find early because usually there are no symptoms. Some women who have early stage ovarian cancer may have symptoms such as vague gastrointestinal or GI discomfort, pressure in the pelvis, pain, swelling of the abdomen, and shortness of breath. Most of the time however, there is no symptoms or they are very mild. By the time symptoms do appear, the cancer is usually advanced.

Certain factors affect treatment options and prognosis or chance of recovery. The treatment options and prognosis or the chance of recovery depend on the age of the patient and general health, the type and size of the tumor, and the cancer stage.

After ovarian epithelial cancer has been diagnosed, tests are done to find out if cancer cells have spread within the ovaries or to other parts of the body. The process used to find out if the cancer has spread within the ovary or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. An operation called a laparotomy is usually done to find out the stage of the disease. A doctor must cut into the abdomen and carefully look at all the organs to see if they contain cancer. The doctor will also perform a biopsy or a cut out small pieces of tissue so they can be looked at under a microscope to see whether they contain cancer. Usually the doctor will remove the cancer and other organs that contain cancer during the laparotomy.

Original Text here:

http://www.medhelp.org/lib/cancernet/200950.htm

Endometrial Cancer General Information about Endometrial Cancer

gynecologyinstruments — Sun, 01 Jul 2007 09:46:39 +0000

Endometrial cancer is a disease in which malignant cancer cells form in the tissues of the endometrium. The endometrium is the lining of the uterus. The uterus is a hollow, muscular organ in a womans pelvis where a fetus grows. Cancer of the endometrium is different from cancer of the muscle of the uterus, which is called sarcoma of the uterus.
Endometrial cancer may develop in breast cancer patients who have been treated with the drug Tamoxifen. It I suggested that the patient taking this drug should have a gynecological examination every year and report any vaginal bleeding as soon as possible. Women taking estrogen alone have also been found to have an increased risk of developing endometrial cancer. It has been observed that taking estrogen in combination with progesterone does not increase a womans risk of this cancer.
Possible signs of endometrial cancer include unusual vaginal discharge or pain in the pelvis. Bleeding or discharge not related to menstruation is also common. Difficult or painful urination or dysuria is also common in this kind of disease. Pain during sexual intercourse can also be expected. Pain in the pelvic area is also not uncommon.
Because endometrial cancer begins inside the uterus, it does not usually show up in the results of a Pap test. Because of this, a sample of endometrial tissue must be removed and examined under a microscope to look for cancer cells. Endometrial biopsy is a process that could be used to diagnose endometrial cancer. It involves the removal of tissue from the endometrium by inserting a thin, flexible tube through the cervix and into the uterus. The tube is being used to gently scrape a small amount of tissue from the endometrium and then remove the tissue samples. The tissue is viewed under a microscope to look for cancer cells. Dilatation and curettage is also another procedure. It is a surgical procedure to remove samples of tissue or the inner lining of the uterus. The cervix is dilated and a curette is inserted into the uterus to remove tissue. Tissue samples may be taken for biopsy. This procedure is also commonly called a D&C.
There are several stages of endometrial cancer. Stage I cancer is found in the uterus only. The cancer is in stage II, if the cancer has spread from the uterus to the cervix, but not beyond the cervix. In stage III, the cancer has spread beyond the uterus and cervix, but has not spread beyond the pelvis. In stage IV, cancer has spread beyond the pelvis.
Four types of standard treatment are used. Surgery is the most common treatment for endometrial cancer. Hysterectomy is one possible procedure. It is a surgical procedure to remove the uterus and cervix. Bilateral salpingo oophorectomy is another surgical procedure. It is a surgical procedure to remove both ovaries and both fallopian tubes. Radical hysterectomy is another surgical procedure that is done to remove the uterus, cervix, and part of the vagina. The ovaries or lymph nodes may also be removed.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Chemotherapy is also done to endometrial cancer patients.
Radiation therapy is a cancer treatment that uses high energy x rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Hormone therapy is another possible treatment. It is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow.

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http://www.uhseast.com/145333.cfm

The Vaginal Speculum

gynecologyinstruments — Mon, 14 May 2007 03:01:01 +0000

A complete gynecologic exam must include a thorough physical examination, a visualization of the vulva to look out for abnormal lesions. An internal examination to palpate for masses and the possibility of tenderness in the vaginal walls or cervix. This involves inserting two adequately lubricated fingers into the vaginal orifice and assessing the anatomy through palpation or feeling. A bimanual exam must also be performed to rule out masses in the vagina and the rectum. An adequately lubricated finger is inserted into the vagina (usually the forefinger) and another finger (usually the middle finger) is inserted into the rectum. The examiner’s other hand is then used to feel the reproductive organs through the abdomen. Most importantly, the visualization of the cervix and the vaginal walls to ensure the sexual health of the patient. This also allows the physician to obtain samples of the discharges from the cervix and vagina.

This is achieved using a vaginal speculum which dilates the vaginal vault and allows visualization of the cervix. There are different types of vaginal specula. It usually consists of two blades and a handle that can be locked by fastening a screw once the blades click into place. The most common specula is the Graves vaginal speculum, otherwise known as the duckbill speculum. Its blades range from 1/2 inches to 1.5 inches in width. Its length ranges from three (3) inches to four and three fourths inches. The superior blade is usually shorter than the inferior blade. This is usually used in women who have had children or are sexually active. The Pederson vaginal speculum is similar to the Graves vaginal speculum, however, its blades are more narrow and flatter. Their small size makes them popular for use in pediatric patients. The first two specula types dilate the vaginal vault anteroposteriorly, which means it makes the opening taller. Another type of vaginal speculum called the side opening vaginal speculum dilates the vagina laterally, or it makes the vagina wider. The dimensions of this speculum are one and one fourth inches in width by four inches in length. To insert a vaginal speculum, the introitus or vaginal opening must be stretched open by two moistened fingers. The speculum must then be warmed and moistened with lubricant or warm water, afterwhich it is inserted laterally into the vaginal opening so as not to cause pain or discomfort. Once the speculum passes over the fingers holding the introitus open, they are turned horizontally. Insertion is continued to the back of the vagina, the speculum must be held at a 45 degree angle to the examination table. The speculum blades are then opened to reveal the cervix and the vaginal sidewalls. The blades are secured by compressing them moving the top one forward until a click is heard. Then the speculum is locked by rotating the mechanism clockwise. The examination and sampling of the cervix and vaginal sidewalls may then be performed. Examinations with the speculum are dreaded by women visiting their gynecologist, yet this tools of torture as most call them, have saved more than its fair share of patients from cervical cancer thru vigilant screening.

Retractors for Abdominal Surgery

gynecologyinstruments — Mon, 14 May 2007 03:00:36 +0000

Gynecology is essentially a study of women, their diseases, infections and illnesses. The specialization focuses on the woman’s reproductive organs namely the uterus, fallopian tube, ovaries, vagina and vulva. This specialization has come a long way in terms of the care of the female. While inspections were previously one of compromise–a procedure designed to preserve the chastity of the woman. The procedure consisted of the woman standing in front of the doctor, the doctor kneeled in front ofher and inspected her reproductive organs beneath her skirt.

He was not allowed to visualize these organs, only palpate them. Today, visiting a doctor entails that reproductive organs be visualized and internal organs examined. Numerous procedures have been deviced to safeguard patients in general and women in particular from diseases. Prevention has become a by-word. In the event of illness that requires surgical intervention, like myomas, endometrioses refractory to medical treatment, ovarian torsion and ectopic pregnancies, surgery through the abdomen proves to be the easiest, safest way to access them. A variety of retractors have been designed to allow the surgeon a clear view of his operative field, while other retractors have the added advantage of preventing iatrogenic damage or doctor-caused damage. They may also be shaped in such a way that they follow the contours of the abdominal wall. Retractors may be handheld or are self-retaining. Handheld retractors come in a variety of shapes and sizes. Among the most commonly used handheld retractors are the DeLee Bladder retractor or the bladder blade. The retractor consists of a blade and a handle. The blade is tear shaped, with its retracting portion folded in a concave shape to allow better access during caesarean section. Its blade may be off-set to the right or left. Its width protects the bladder from iatrogenic damage during caesarean section because of the close proximity of the lower uterine segment to the bladder. The Richardson retractor, although used by other surgical specializations, is also a mainstay in gynecologic surgery. It may be double- or single-edged. The double edged Richardson retractor may be used to retract using both ends, one end being smaller than the other. The handle is located at the center. The blades of the retractors are curved at the edges and are at right angles with the handle. The single edged Richardson retractor on the other hand has the same blade but has its handle on the other end. The Richardson retractor comes in different sizes depending on the amount of tissue to be retracted. Another useful retractor is the O’Sullivan-O’Connor retractor or the Irish retractor. It is used in retracting the abdominal or pelvic wall it is self-retaining which means that once it is applied it need not be held anymore. These retractors also have moistened lap pads that allow padding between the blades and the tissues preventing damage. The surgeon can then work without having to worry about his field of vision nor the damage the retractor can cause to the surrounding tissues. Retractors come in different shapes and sizes yet they serve the same purpose, to allow the doctor to have a good visualization of the operating field and give him ample soace to maneuver. Its just a matter of convenience.

Curettes and Curettage

gynecologyinstruments — Mon, 14 May 2007 03:00:06 +0000

Other conditions that use the dilatation and curettage procedure are Polycystic Ovarian Syndrome wherein the endometrial tissues lining the uterus build-up and become so thick because there is no ovulation hence no normal means to get rid of it. Dilatation and Curettage used to be the most preferred method of abortion, but the World Health Organization warrants its use only when manual vacuum aspiration is unavailable. However, in third world countries, the use of dilatation and curettage as a method of abortion is still employed, but not by doctors. The process involves the measurement of the depth of the intrauterine cavity using a uterine sound, only then is the curetting begun. The curette is inserted into the cervix after its proper dilatation and tissues are scraped out using the sharp edge of the instrument. The Sims curette is a sharp curette used to scrape the endocervical and endometrial linings. It is approximately 11 inches long and its blades range from sizes 1 to 6. The surgeon stops scraping once the uterus has a gritty or sandlike consistency. The procedure is performed slowly and firmly but not to roughly because this may result in perforation and may require an emergency laparotomy or hysterectomy to stop the bleeding. Formation of scar tissue could also result if the curettage is done roughly. This could seal the uterus shut rendering the woman infertile. This condition is called the Asherman syndrome. The blunt blades of Thomas curettes, also sized 1 to 6 are used to finish off the curetting process. For diagnostic processes the Kevorkian curette or the endometrial curette is used to obtain endometrial tissue samples. It is mainly for cutting the peduncle of the growth in contrast to the Sims and Thomas curette that scrape. Its blade is square shaped incontrast with the spoon shaped head of the other two curettes.

Obstetric Forceps

gynecologyinstruments — Mon, 14 May 2007 02:43:22 +0000

The secret forceps, today known as the Obstetric forceps or the Simpson delivery forceps because it was James Simpson who reinvented the instruments to fil the contours of the pelvis and fetal head. The forceps come in two parts and are handed to the obstetrician one at a time. They have four major components: The double curved, spoonlike articulated blades that are used in the expulsion of the fetal head. These blades graps the fetal head and have a cephalic curve. A shape fasioned to follow the contours of the fetal head. blades may be oval or elliptical and may have a hole in the middle or may just be plain solid. The pelvic curve of the blade are angled at 90 degrees and was designed to conform to the pelvic axis. The shanks connect the blades to the handles and provide the length of the device. They are either parallel or crossing. The lock is the connection between the shanks. Many different types have been designed. The handles are where the operator holds the device and applies traction to the fetal head. Use of the forceps are indicated during the second stage of labor when dystocia or difficulty in delivering the baby is encountered. It aids the mother who is too fatigued to push her baby out or who has been given epidural anesthesia. An epidural anesthesia numbs the pelvic floor muscles making it difficult for them to guide the head of the baby into a favourable position for birth. It is also indicated to help the mother who has an existing medical condition like a heart problem that limits her ability to exert force. The use of the forceps allows to remained relaxed, thus preventing cardiac decompensation and preserving her health. (108) It may also be used to rescue a baby who is in distress. A baby in distress has an abnormally high or abnormally low cardiac rate, and is in danger of dying.

The use of the forceps has several prerequisites to ensure a successful delivery. First and foremost, the first stage of delivery should have been completed, which means that the maternal cervix should have been dilated to ten (10) centimeters. This is necessary to allow easy passage of the fetal head and to prevent cervial laceration due to the passage of the fetus. Second, the head of the baby should be enganged so that it is at the level of or beyond the ischial spines of the mother. This ensures that the baby can easily be pulled out because most of its body has exited the uterus. The membranes or the amniotic sac should have been ruptured to allow a firmer grip on the fetal head. The pelvis of the mother must also be wide enough in proportion to the size of the baby to allow easy passage. Cephalopelvic disproportion must be ruled out prior to the onset of labor with the use of X-Ray pelvimetry. The bladder and bowels should also be evacuated to maximize to space. The mother and family should also be informed prior to the application of the forceps about the pros and cons of the procedure. Facial injury secondary to forceps extraction is always a possiblity and they should be made to understand this.

Obsterical forceps have a come a long way since the 16th century, although its structure remains the same, the magnitude of its contribution to women worldwide is immeasurable. By coming out of its box, it has saved countless families unnecessary grief.

Gynecologic Tools: An Overview

gynecologyinstruments — Mon, 14 May 2007 02:40:16 +0000

Gynecologic intstruments have been used since ancient Roman times. In an archaologic expedition from Pompeii, vaginal specula, curettes and dilators were discovered. The ancient vaginal specula were large and easily identifiable because they closely resemble the instruments dreaded and feared by most women having gynecologic check-ups today. They maintained the same duck-billed appearance necessary for dilating and exposing the vaginal vault. Another documented instrument was the vaginal dilator or the dioptra. It was made up of a priapiscus with two (2) to four (4) dovetailing valves. A handle and screw mechanism allow this device to be opened and closed, very similar to the mechanism of vaginal speculum today. Greco-Roman writers describe the dioptra as a device made especially for the vagina and recommended its use for the diagnosis and treatment of vaginal and uterine disorders. These instruments are said to be typical examples of gynecologic surgical tools for nearly a millenium since little or no innovations were made on their basic structure until the 20th century. However, very few of these devices can be seen today. The surviving instruments can only be found in museums.

Throughout the 20th century, different innovators have fashioned instruments to adapt to the growing field of gynecologic surgery. In the United States, James Marion Sims is recognized as the father of American Gynecology for his significant contribution in the repair of vesicovaginal fistulas and for devicing the speculum of Sim, a reinvention of the vaginal speculum, to achieve greater exposure during vaginal operations. Black slaves suffered in his efforts in perfecting vesicovaginal fistula repair beacuse he performed these operations without anesthsia. Other innovators have fashioned and innovated ancient instruments to accomodate the needs of the modern Obsterician-Gynecologist.

Today , a wide aramamentarium exists for the Obstetrician-Gynecologist. Familiarizing oneself with these tools and how they are used is necessary in becoming an effective and skilled surgeon, beacuse these instruments should be extensions of the hands of the surgeon. Retractors have evolved from handheld to self-retaining ones. Weights added to a vaginal speculum transformed it into a self-retaining vaginal retractor indespensable to procedures like currettage. In procedures like Caesarean Section and Abdominal Hysterectomy where the surgeon has to work in close proximity to the bladder, retractors like the DeLee Bladder Retractor have made it easier for surgeons to avoid injury to the bladder, lessening morbidity and intraoperative referrals. Currettes, although closely resembling their prototypes in the ancient period, have also been reinvented for better dexterity and easier usage. Innovations like the THomas currette, Sims currette and Kevorkian currette simply show the availability of instruments for any given need. Forceps and Scissors have also evolved to cater to the different tissues they are used on. Jorgensen scissor and the Mayo-Noble scissors may be used for cutting heavy tissue, while the Lister or bandage scissors are employed to cut the uterus open during Caesarean section. Disposable variants of these instruments have also been invented to ensure one time use and maintain sterility and asepsis. Every carpenter must know his tools, just like every gynecologist must know his instruments.