Cervical Conization (Loop Electrosurgical Excision Procedure and Large Loop Excision of the Transformation Zone Conizations)

Chapter 248 Cervical Conization (Loop Electrosurgical Excision Procedure and Large Loop Excision of the Transformation Zone Conizations)



DESCRIPTION


Cervical conization is a diagnostic or therapeutic procedure that removes a cone-shaped specimen from the uterine cervix. Loop electrocautery excisional procedure (LEEP, also known as large loop excision of the transformation zone [LLETZ]) uses electric current instead of a knife to remove the cervical tissue.



INDICATIONS


Histologically verified advanced epithelial atypia (for diagnosis or therapy) or inability to adequately evaluate the cervix through colposcopy.



CONTRAINDICATIONS


Coagulopathy, advanced pregnancy, known or suspected allergy to the agents used.



REQUIRED EQUIPMENT



• Skin (vaginal) preparation materials (iodine-based antibacterial solution [e.g., Betadine] or other suitable cervical cleansing agents)

• Sterile gloves

• Nonconductive vaginal speculum

• Electrosurgical generator with output capability of at least 50 watts in both coagulation and cutting modes, a variety of waveform outputs (pure cut, blended current, and coagulation current), patient grounding pad monitor, and isolated circuitry.

• A variety of loop electrodes (size and shape to be determined at the time of the procedure based on the size and shape of the cervix and lesion to be removed)

• A smoke evacuator with odor and viral filter

• Monsel paste (ferric subsulfate solution allowed to evaporate to the consistency of paste)

• 5% acetic acid or Lugol solution (super-saturated potassium iodide)

• Kevorkian or similar endocervical curette

• Histology fixative (10% formalin) in containers

• Syringe with 25- or 27-gauge 1.5-inch needle for anesthetic injection, 1% or 2% lidocaine with or without 1 : 100,000 epinephrine

• 12-inch needle holder, 2-0 absorbable suture material (or similar)


TECHNIQUE


After informed consent has been obtained, the patient is placed in the dorsal lithotomy position and a return electrode (“grounding pad”) is placed on the patient’s thigh with the long edge directed toward the hip.

Related posts:

  1. Anemia
  2. Toxic Shock Syndrome
  3. Uterine Anomalies: Bicornuate, Septate, and Unicornuate Uterus
  4. Cervical Cancer

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Cervical Conization (Loop Electrosurgical Excision Procedure and Large Loop Excision of the Transformation Zone Conizations)

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