Conization Of Cervix

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

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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 • •

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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 9o'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

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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

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CIN/ High-grade squamous intraepithelial lesions (HSIL)/ Lowgrade 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