A cold knife conization is done in most Slovak hospitals and outpatient surgeries and under general anaesthesia. In this procedure, the gynaecologist will use a scalpel to remove, in the shape of a cone, the significant and estimated portion of the possible affected tissue of the cervix visible with the naked eye. In routine scalpel conization, the cervix tissue is often removed “blindly”, without an exact colposcopic survey of the location of the abnormal cells before the procedure. Thus, large tissue losses and often malformations of the cervix occur with scalpel conization, as well as problematic healing. Patients who have undergone routine scalpel conization have a significantly higher risk of preterm birth and amniotic fluid outflow, infertility and subfertility than patients after colposcopically targeted LEEP (Loop Electrosurgical Excision Procedure) conization! In contrast, LEEP conization is a highly accurate, effective and minimally invasive procedure that removes a small but targeted part of the cervical tissue with pre-cancerous changes under a high-end colposcope (a high-resolution magnifying glass). It does not require hospitalization or general anaesthesia. Before the procedure itself, an expert colposcopic examination is always done in order to exactly locate the area showing abnormal changes. The operating equipment and procedure are individually adapted depending on the characteristics of the lesion. LEEP conization, also known as LLETZ (Large-Loop Excision of the Transformation Zone) conization under colposcopy control, does not require an anaesthetic; it is performed on an outpatient basis with the application of a local anaesthetic to the cervix. The instrument is an electrified wire loop at the end of a narrow rod. Using the loop, the doctor gently removes a small part of the affected tissue, which a histologist then examines under a microscope. The aim of this procedure is to accurately remove any abnormal cells in the cervix to reduce the likelihood of cancer.
The patient usually comes to this procedure after a previous correlation of cytological, expert colposcopic and biopsy examination showing a high-grade change, which histologically are CIN 2, CIN 3, AIS, etc. and with the prerequisite that the patient be 25 years or older and not pregnant. There are two situations when it is possible, though not completely optimal, to perform LEEP conization without prior colposcopically targeted biopsy examination due to the high probability of a severe pre-cancerous change. This is in the case of being positive for the HR-HPV virus (genotype 16) and HSIL cytology or being positive for the HR-HPV virus (regardless of genotype) and HSIL cytology with no screening in the last 5 years. In other cases, a previous expert colposcopic examination with targeted biopsy and histological examination is appropriate.
LEEP – a high-frequency loop electrosurgical excision procedure – is a method during which the changed tissue is removed using a small wire “loop”. During this operation, the superficial part of the cervix, the so-called conus, is excised from the cervix. Electrical energy is used in the cutting; it does not thermally damage the cervix. This is today the most commonly used method for treating cervical dysplasia. This method is also highly suitable for women who are planning to have a pregnancy in the future. With LEEP conization, the conus is removed electrosurgically, and the bleeding in the resulting wound is stopped by the action of the electric current. The conus is sent for histological examination, which determines the exact nature and severity of changes to the cervix. The operation is done under local anaesthesia by so-called “deadening” the site of the procedure. In exceptional cases, bleeding can occur during the procedure or in the post-operative period. This bleeding is typically minor and minimal; its occurrence is very rare, but it cannot be 100% excluded. The rare occurrence of inflammatory complications is likewise very rare and requires antibiotic treatment. Pre-cancerous changes can recur even after the operation; therefore, post-operative follow-up in the form of colposcopic follow-up examinations are required. Moderate lower abdominal pain is relieved by routine pain medication. For several days to a week after the operation, light bleeding or so-called spotting is also possible. After the procedure, it is necessary to maintain a calm regime with bed rest and to avoid lifting heavy loads and taking part in sports. Taking a shower is suitable but swimming is not, and behaviour that would lead to bleeding or infection should be avoided (do not use menstrual swabs or vaginal lavages, and limit sexual intercourse for at least 3-4 weeks). The procedure itself does not require special preparation. For the possibility of heavier bleeding, we recommend that for 3 weeks prior to the operation patients not use drugs that affect blood clotting (acetylsalicylic acid, low-molecular-weight heparin, etc.). Patients are advised to discontinue hormonal contraception 4 weeks prior to the procedure.
At the Centre for Foetal and Gynaecological Diagnostics, we use exclusively patented, disposable, sterile electrodes of the UtahLoop® and UtahBall® brands for LEEP conization. We use C-LETZ® electrodes as part of their specialized shaping; when rotated 360 degrees within the cervical canal, it cuts out a “conical” sample which adapts more closely to the presumed infectious pattern of CIN lesions. Unique in the world for UtahLoop® electrodes is the Y-shape of their shaft and the adjustable Safe-T-Gauge®, with which we can safely select the required maximum depth of the excision. This provides an excellent reference for controlling the depth and, most importantly, prevents excessive cutting of healthy cervical tissue, even if the patient moves during the procedure.
A common electrode does not offer T-loop electrode wire support. This lack of Y-shaft support of the loop wire and the mostly inexpensive wire material causes the loop wire to bend under electric charge and leading to an incorrectly made surgical incision with fragmentation of the samples. This bend is often behind the inadequate removal of the suspicious site with pre-cancerous cervical changes.
The unique UtahLoop® electrode employs an electrode wire made of pure tungsten. The loop is located on a Y-shaft with an adjustable excision depth using the patented Safe-T-Gauge® shaft. This enables excellent precision and exact control over the depth of surgical excision of the affected cervical tissue.
The UtahLoop C-LETZ® conization electrode offers a uniquely shaped wire that is designed for complete removal of glandular lesions. The exact and histologically clear edges of the excision are safely ensured with this unique electrode.
What is it for?
The method serves to treat pre-cancerous changes in the cervix. After the procedure a control test for HR-HPV follows, as well as a cytological examination at 6-month intervals, as this has the highest detection rate for any persistent or recurrent disease. With a positive result of one of these tests, a colposcopic examination with a targeted biopsy of the lesions shown is again recommended.