Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision
CPT4 code
Name of the Procedure:
Conization of cervix; Loop Electrode Excision Procedure (LEEP)
Summary
Conization of the cervix, commonly referred to as LEEP, is a minor surgical procedure involving the removal of a cone-shaped section of abnormal cervical tissue using a thin, low-voltage electrified wire loop. It may be performed with or without additional techniques such as fulguration (cauterization) and dilation and curettage (D&C).
Purpose
The procedure is primarily used to diagnose and treat precancerous changes and early-stage cancers of the cervix. It aims to remove abnormal tissue that could potentially develop into cervical cancer, thereby preventing its progression.
Indications
- Abnormal Pap smear results
- Positive HPV test
- Cervical dysplasia (CIN 2 or CIN 3)
- Early-stage cervical cancer
- Persistent cervical lesions unresponsive to other treatments
Preparation
- Patients may be advised to avoid eating or drinking for a certain period before the procedure.
- Review of current medications and possible cessation of blood-thinning medications.
- Preoperative pelvic exam and possibly diagnostic tests like colposcopy or biopsy.
Procedure Description
- The patient is positioned in a gynecological exam position.
- Local anesthesia is typically used to numb the cervix.
- A speculum is inserted to widen the vaginal opening.
- The electrified wire loop is carefully used to excise the cone-shaped segment of abnormal cervical tissue.
- Additional techniques such as fulguration or dilation and curettage might be employed to treat or remove residual abnormal tissues.
- The excised tissue is sent for pathological examination to confirm the diagnosis and ensure clear margins.
Duration
The procedure typically takes about 20-30 minutes.
Setting
LEEP can be performed in an outpatient clinic, hospital, or surgical center.
Personnel
- Gynecologist or specialized surgeon
- Nursing staff
- Occasionally, an anesthesiologist if general anesthesia is needed (though local anesthesia is more common)
Risks and Complications
- Bleeding
- Infection
- Cervical stenosis
- Potential impact on future pregnancies (e.g., cervical incompetence)
- Temporary discomfort or cramping
Benefits
- Effective removal of abnormal tissue, reducing the risk of cervical cancer.
- Rapid recovery with minimal downtime.
- Accurate diagnosis and targeted treatment of abnormal cervical cells.
Recovery
- Patients may experience mild cramping and spotting for a few days.
- Avoid heavy lifting, douching, or using tampons for a few weeks as advised.
- Sexual intercourse should be avoided until the cervix heals, typically around 4-6 weeks.
- Follow-up appointments will be scheduled to monitor healing and ensure clear margins.
Alternatives
- Cryotherapy (freezing abnormal cells)
- Laser ablation (destroying abnormal cells with laser)
- Watchful waiting with frequent monitoring in cases of mild dysplasia
- Each alternative has its pros and cons, such as varying recovery times and levels of effectiveness in treating or preventing cancer.
Patient Experience
- During the procedure, patients might feel pressure and mild cramping.
- Post-procedure discomfort can typically be managed with over-the-counter pain relief.
- Emotional reassurance and physical comfort measures will be provided by healthcare professionals throughout the process.