Name of the Procedure:

Destruction of Lesion(s), Vulva; Extensive (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery).

Summary

This procedure involves the removal of abnormal or harmful lesions on the vulva using various techniques, including laser surgery, electrosurgery, cryosurgery, or chemosurgery. The term "extensive" indicates that the treatment covers a larger area or multiple lesions.

Purpose

The procedure addresses medical conditions involving abnormal growths on the vulva, such as warts, precancerous lesions, or other skin disorders. The primary goal is to remove these lesions to prevent complications, alleviate symptoms, and improve the overall health of the vulvar tissue.

Indications

• Presence of vulvar lesions such as warts, precancerous lesions, and certain types of skin disorders.
• Symptoms include pain, itching, or discomfort.
• Patient has not responded to less invasive treatments.

Preparation

• Patients may be advised to fast for a certain period before the procedure if general anesthesia is used.
• Medication adjustments might be necessary, particularly for blood thinners.
• Pre-procedure diagnostic tests may include a biopsy of the lesion, blood tests, and imaging studies.

Procedure Description

1. The patient is positioned appropriately, usually in a lithotomy position.
2. Anesthesia is administered, which could be local, regional, or general depending on the extent of the procedure.
3. The lesion(s) are identified and marked.
4. The chosen method for lesion destruction is applied:
   • Laser Surgery: A focused beam of light removes the lesion.
   • Electrosurgery: High-frequency electrical currents are used to cut tissue or coagulate blood vessels.
   • Cryosurgery: Extreme cold is applied to freeze and destroy abnormal tissue.
   • Chemosurgery: Chemical agents are used to destroy the lesion.
5. The area is then cleaned and dressed as necessary.

Duration

The procedure typically takes between 30 minutes to 2 hours, depending on the number and size of the lesions.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Surgeons specialized in gynecology.
• Nurses or surgical assistants.
• Anesthesiologists, if anesthesia is required.

Risks and Complications

• Common risks: Pain, swelling, infection, and bleeding at the site of lesion removal.
• Rare risks: Scarring, changes in vulvar appearance, allergic reactions to anesthesia, or delayed wound healing.

Benefits

• Removal of harmful or precancerous lesions, preventing further complications.
• Alleviation of symptoms such as pain and itching.
• Improved vulvar health and comfort.

Recovery

• Patients may experience mild discomfort, swelling, or redness at the treatment site.
• Pain medication and topical ointments may be prescribed.
• Patients are generally advised to avoid strenuous activities, sexual intercourse, and tampon use for a specific period.
• Follow-up appointments may be scheduled to monitor healing.

Alternatives

• Watchful waiting for smaller, asymptomatic lesions.
• Topical treatments for certain types of lesions.
• Surgical excision for more localized lesions.

Pros and Cons of Alternatives:

• Watchful Waiting:
  • Pros: Non-invasive, no immediate risks.
  • Cons: Potential for lesions to grow or become symptomatic.
• Topical Treatments:
  • Pros: Non-invasive, can be done at home.
  • Cons: May not be effective for all lesion types or extensive areas.
• Surgical Excision:
  • Pros: May completely remove lesions in a single procedure.
  • Cons: Involves a surgical incision, longer recovery.

Patient Experience

• During the procedure, the patient may feel sensations related to the type of anesthesia used.
• Post-procedure discomfort is managed with pain relief measures and comfort strategies.
• Most patients recover fully and return to normal activities within a few weeks, following the specific guidance of their healthcare provider.