Cervical Procedures

In this section we briefly describe the most common procedures performed to treat cervical dysplasia.

Cervical Ablation/vaporization

• This is the wide removal (excision) of part of the cervix. The part removed is often cone-shaped, this is why it is also called cervical conization;
• It differs from small cervical biopsies usually performed at the time of colposcopy in two or three often random locations in the cervix;
• Most common indications:

1. 1. Diagnosis confirmation and treatment for moderate or severe cervical dysplasia (CIN 2 or 3);
   2. Confirmation of suspected invasive cervical cancer; and
   3. Treatment of cervical cancer at the earliest stage in women who have borne no children yet.

• The following techniques are used for cervical conization:

1. 1. The LOOP electrosurgical excision procedure (aka LEEP or LLETZ) with local sedation or often mild sedation (intoxication). (See Fig. 1 and 2);
   2. Laser cervical conization, with local sedation and/or mild sedation (intoxication) in many cases;
   3. Cold-knife cervical conization, always performed under general sedation. (See Fig. 3 and 4).

• Cervical conization done for suspected or confirmed severe dysplasia or early cervical cancer and as treatment, usually requires the removal of a large section of the cervix. This eventuality needs to be explained to the patient. In case of a future pregnancy, a preventive cervical ligature may be required in order to avoid possible premature childbirth;
• In case of suspected early cervical cancer, knife cervical conization is preferred over the LOOP technique because it gives surgical limits without causing thermal damage, which allows for a more detailed histological examination;
• Knife cervical conization is usually performed by gynecology specialists specialized in gynecologic oncology;
• Many studies have shown similar efficacy among the different cervical conization techniques in terms of therapy, recurrence or persistence of the dysplasia. The specialist should handle each case separately;
• After cervical conization, the female patient recovers the same day and she is able to return to her activities the following day. It is recommended that the patient avoid intercourse, swimming or using tampons and vaginal douching for about 3-4 weeks.