CONIZATION OF CERVIX

REASON FOR VISIT

DIAGNOSTIC CONIZATION

• Finding epithelial cell abnormalities

• High-grade squamous intraepithelial lesions (HSIL)
• Low-grade squamous intraepithelial lesions (LSIL)
• Unsatisfactory colposcopy
• CIN
• Microinvasive cancer
• Premalignant glandular epithelium
• Malignant glandular epithelium

THERAPEUTIC CONIZATION

• CIN grades 2 and 3

RISK ASSESSMENT

• Pregnancy
• Bleeding disorders
• Allergies to anesthesia
• Allergies to medication
• Heart disorders
• Anemia

PREPARATION OF THE PATIENT

• Blood tests
• Urinalysis
• ECG
• Chest X- ray
• Biopsy cervix
• USG
• Colposcopy
• Schiller test
 • Blood thinning medication was stopped
• Douching was stopped 24 hrs before procedure
• Tampons were avoided for 24 hrs before procedure
• Intercourse was avoided for 24 hrs before procedure

ANESTHESIA

• General anesthesia
• Spinal anesthesia
• Local anesthesia

POSITION OF THE PATIENT

Lithotomy position

THE PROCEDURE

COLD-KNIFE CONIZATION

• A weighted speculum was inserted into the vagina.

• For preconization cerclage 1-0 chromic catgut sutures with
attached general closure needles were inserted at the 3- and 9-
o'clock positions close to the vaginal fornix
• The anterior portion of the cerclage was done by imbricating the
suture in the anterior lip and by tying it to the needle-free end of
the suture already anchored at the 9-o'clock position.
• The needle-ended suture at the 9-o'clock suture was used to
complete the cerclage posteriorly.
• A black silk suture was inserted in the cervix at the 12-o'clock
position
• Cervix length and position of internal os was determined
• The cervix was painted with Lugol solution and
• Lateral traction was applied to the angle sutures.
• With using No. 11 blade incision was given at the 3- or 9- o’clock
position and incision extended to posteriorly
• The exocervical incision was given including the entire
transformation zone, with a 2- to 3-mm margin.
• Deep endocervical incision was given
 • The cone specimen was removed in one piece
• The endocervical canal was curetted with a Kevorkian
endocervical curette
• Monsel solution was used to reduce oozing

LASER CONIZATION

• The exocervical margins were outlined with 0.5- to 1-mm dots

produced by laser energy at a power setting of 20-50 W.
• A laser incision was performed to connect the dots and extended
to a depth of 3-5 mm
• Vaporization conization was done
• By using laser/ scalpel/ Mayo scissors the procedure was
completed.

LOOP ELECTROSURGICAL EXCISION PROCEDURE

• The patient was placed in a lithotomy position and was attached

to a grounding pad.
• An insulated speculum, connected to smoke-evacuator tubing,
was inserted into the vagina
• epinephrine injection was given
• with using the loop transformation zone was removed
• Tissue was ablated to a depth of approximately 1 cm in the first
pass
• Using a 1-cm by 1-cm loop, more of the endocervical canal was
excised in a second pass from the crater base.
• After exposing the cervix, LEEP procedures was performed with
extreme rapidity
• The loop was directed in a transverse direction/ anteroposteriorly
• Raw cervix was painted with Monsel solution to control oozing.

AFTER PROCEDURE

• Specimens were sent for histopathological study

FINDINGS
 • CIN/ High-grade squamous intraepithelial lesions (HSIL)/ Low-
grade squamous intraepithelial lesions (LSIL)/ Premalignant
glandular epithelium/ Malignant glandular epithelium is identified

POSTOPERATIVE CARE

• Use antibiotics as prescribed

• Use pain medication as prescribed
• Avoid intercourse for 2-3 weeks
• Avoid the use of vaginal tampons 2-3 weeks.

COMPLICATIONS

• Bleeding
• Cervical stenosis
• Cervical incompetence
• Infections