Cervical ablation is the removal of some of the outer layers of the cervix. Gynecologists perform cervical ablation when there is evidence or suspicion of cervical cancer. If a Pap smear detects abnormal cells on the surface of the cervix, cervical ablation can help determine if these abnormalities indicate cancer. If the cells are pre-cancerous or are in a early stage of cancer, cervical ablation can also serve as a conservative treatment option to a hysterectomy.
Conization is the technique of ablating the cervix by cutting a cone-shaped section from its surface. When a scalpel is used to cut the section, it is called cold-knife conization. Cold-knife conization is the best technique for diagnosing cervical cancer, since it provides the cleanest separation between the normal and the abnormal cervical cells. Unlike other ablation techniques, it requires general anesthesia and is usually performed in a hospital operating room. It can also cause more bleeding, however, a procedure know as cervical cerclage is usually performed first, in order to minimize this. The need for cerclage and general anesthesia make cold-knife conization more expensive and time-consuming than other techniques, so it is usually used only when diagnostic accuracy is essential. Post-operative bleeding following cold-knife conization is usually no greater than bleeding from other techniques, providing that cerclage is used.
- Conization is the technique of ablating the cervix by cutting a cone-shaped section from its surface.
- The need for cerclage and general anesthesia make cold-knife conization more expensive and time-consuming than other techniques, so it is usually used only when diagnostic accuracy is essential.
Abnormal Bleeding After a D&C
The loop electrosurgical excision procedure, or LEEP, uses a wire loop with electric current running through it to conize the cervix. The current heats the loop so that blood vessels are automatically cauterized as the section of the cervix is removed. As a result, LEEP causes much less bleeding then cold-knife conization and does not require general anesthesia. LEEP is usually performed in a doctor's office, rather than an operating room. Since cerclage is usually not performed first, LEEP is slightly more likely to lead to post-operative bleeding than cold-knife conization with clerclage, but such bleeding is almost always minor and easily treated. LEEP is used much more frequently then cold-knife conization, since it is faster, easier, less expensive and still gives reasonably useful diagnostic results.
- The loop electrosurgical excision procedure, or LEEP, uses a wire loop with electric current running through it to conize the cervix.
- Since cerclage is usually not performed first, LEEP is slightly more likely to lead to post-operative bleeding than cold-knife conization with clerclage, but such bleeding is almost always minor and easily treated.
Lasar Cervical Ablation
Another procedure for cervical ablation uses a laser to cut a section from the cervix. The advantages of the laser method lie somewhere between those of cold-knife conization and LEEP. Lasar ablation produces less bleeding than cold-knife conization, but more than LEEP, so cerclage is sometimes used first. Laser ablation can be performed under local anesthetic, although, like cold-knife conization, general anesthetic may give better results by preventing the patient from unexpectedly moving. Laser ablation takes longer than either cold-knife conization or LEEP and is considerably more expensive than both. It is roughly equivalent to LEEP for diagnostic purposes. The major advantage of laser ablation lies in its ability to remove tissue from the surface of the cervix to depths much more precise than either cold-knife conization or LEEP.
When the purpose of the ablation is more therapeutic than diagnostic, the laser can remove exactly as much abnormal tissue as is necessary while leaving as much normal tissue as possible. This helps avoid future problems with fertility and childbearing. Despite these advantages, a study published in the February 2003 issue of the journal "European Journal of Obstetrics & Gynecology" found no significant difference between laser ablation and the other two techniques in obstetrical outcomes after three years 2.
- Another procedure for cervical ablation uses a laser to cut a section from the cervix.
- Laser ablation can be performed under local anesthetic, although, like cold-knife conization, general anesthetic may give better results by preventing the patient from unexpectedly moving.
Abnormal Bleeding After a D&C
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- "Williams Gynecology"; John O. Schorge; 2008
- European Journal of Obstetrics & Gynecology: Randomized Study Comparing Three Techniques of Conization
- Fertility and Sterility: Indications and Options for Endometrial Ablation
- Nam KH, Kwon JY, Kim YH, Park YW. Pregnancy outcome after cervical conization: risk factors for preterm delivery and the efficacy of prophylactic cerclage. J Gynecol Oncol. 2010;21(4):225–229. doi:10.3802/jgo.2010.21.4.225
- Ciavattini A, Clemente N, Delli carpini G, et al. Loop electrosurgical excision procedure and risk of miscarriage. Fertil Steril. 2015;103(4):1043-8. doi:10.1016/j.fertnstert.2014.12.112
- Kyrgiou M, Mitra A, Arbyn M, et al. Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis. BMJ. 2014;349:g6192. doi:10.1136/bmj.g6192
- Cleveland Clinic. Simple procedure treats cervical cancer early. January 23, 2014.
- The American Congress of Obstetricians and Gynecologists. Loop electrosurgical excision procedure (LEEP). July 2017.
Sydney Hornby specializes in metabolic disease and reproductive endocrinology. He is a graduate of Claremont McKenna College and Drexel University College of Medicine in Philadelphia, where he earned his M.D., and has worked for several years in academic medical research. Writing for publication since 1995, Hornby has had articles featured in "Medical Care," "Preventive Medicine" and "Medical Decision Making."