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Embryology

Oogenesis and Spermatogenesis The process of fertilisation involves the union of female and male gametes, the ovum and spermatozoon, respectively. In humans there is a ready supply of spermatozoa constantly available from the normal healthy male after the age of puberty. By contrast, the normal healthy female will bring only one ovum to maturity and ovulation in each 28-day cycle. Oogenesis During fetal life the developing…

Clinical Genetics

Clinical genetics is the specialty concerned with the diagnosis and investigation of disorders which are thought to have a genetic basis. The clinical genetics team is multidisciplinary and consists of consultants and specialist registrars working closely with genetic counsellors and laboratory-based diagnostic genetic scientists and cytogeneticists. Genetic risk assessment and non-directive counselling are an important part of the clinical workload and may involve both the proband…

Structure and Function of the Genome

This chapter will provide a basic introduction to the human genome and some of the tools used to analyse it. Genomics and molecular biology have developed rapidly during the last few decades, and this chapter will highlight some of these advances, in particular with respect to the impact on our knowledge of the structure and function of the genome. The basic science described in this chapter…

Cystourethroscopy

Instrumentation The rigid urethroscope is a modification of the cystoscope, designed exclusively for evaluation of the urethra ( Fig. 120.1 ). Because it is primarily a diagnostic instrument, it does not have a bridge. The telescope is shorter and has a 0° viewing angle, which provides a circumferential view of the urethral lumen as the mucosa in front of the urethroscope is distended by a distention…

Major Complications Associated With Laparoscopic Surgery

A number of complications may be associated with laparoscopic surgery. Several of these iatrogenic injuries are unique and peculiar to the laparoscopic procedure itself (i.e., separate from the major surgical objective). For example, total abdominal hysterectomy is associated with the risk of a number of complications inherent to the surgical procedure, whereas laparoscopic hysterectomy has risks associated with the laparoscopic approach plus the hysterectomy portion of…

Robotic Surgery in Gynecology

The application of laparoscopic technology for advanced gynecologic operations resulted in significant patient benefits including reduced blood loss, shorter hospital stay, and a faster recovery as compared with laparotomy. Laparoscopic technology, however, had inherent drawbacks, which resulted in slow incorporation into the surgical practices of most gynecologists for the performance of advanced, and sometimes not so advanced, gynecologic operations. The limitations imposed by two-dimensional vision, instrument…

Laparoscopic Adnexal Surgery

Ovarian Cystectomy Ovarian cystectomy is the treatment of choice for the conservative management of ovarian cysts presumed to be benign. Simple aspiration is associated with a high recurrence rate, and a cyst fluid cytology test is unreliable. Transvaginal ultrasonography is used to evaluate an ovarian cyst. High-risk criteria on ultrasonography for predicting the pathologic diagnosis, such as a cystic-solid mass or ascites, are a contraindication to…

Trocar Placement

The most important prerequisite for proper trocar placement is knowledge of abdominal wall anatomy. Patient position is critical for a safe procedure. The patient is placed in the dorsal lithotomy position with foam-padded leg stirrups (Allen Medical Systems, Acton, Mass.), in which the calves and heels are supported and can be elevated for the vaginal portion of the surgery. The legs are checked for pressure points,…