Cervical Conization

Cervical conization is a surgical procedure performed to remove a cone-shaped section of tissue from the cervix. The removed tissue includes both the outer surface of the cervix (ectocervix) and the inner canal (endocervix). This procedure allows for a closer examination of the cervical tissue and helps diagnose and treat certain cervical conditions.

Types of Cervical Conization:

Cervical conization means the removal of a cone-shaped piece of tissue from the cervix. This can be done using a few different techniques:  

• Cold knife conization (CKC): This is carried out using a surgical scalpel and is usually done under general anesthesia, which removes cervical tissue cleanly to send it for accurate pathological examination. 
• Loop electrosurgical excision procedure (LEEP): This is a procedure used for removing tissue using a heated wire loop and would normally be done under local anesthesia. This makes it a procedure most patients have due to its speed in carrying out such cases. 
• Laser conization: A laser beam is used to remove cervical tissue. LEEP would be considered a common technique.

Cervical conization (Cone Biopsy) Risks

Cone biopsy, while generally safe, carries some risks. These may include:

1. Bleeding: Some bleeding is normal, but heavy bleeding may require medical attention.
2. Infection: There’s a risk of infection at the biopsy site, which can cause fever and pain.
3. Cervical Weakness: Removing a cone-shaped piece of tissue can weaken the cervix, possibly leading to complications in future pregnancies.
4. Changes in Menstrual Cycle: Some women may notice changes in their menstrual cycle after the procedure.
5. Anesthesia Reactions: There can be side effects related to anesthesia, though these are rare.

The procedure for cervical conization typically involves the following steps:

1. Anaesthesia: Cervical conization can be performed under general anaesthesia, regional anaesthesia, or local anaesthesia with sedation. The choice of anaesthesia depends on the patient's medical condition and the surgeon's recommendation.

2. Specimen Removal: The surgeon removes a cone-shaped tissue sample from the cervix using a scalpel, laser, or loop electrosurgical excision procedure (LEEP). The size and depth of the cone biopsy may vary depending on the specific condition being treated.

3. Hemostasis: After the tissue sample is removed, the surgeon ensures hemostasis (control of bleeding) by using techniques such as electrocautery or sutures.

4. Recovery and Follow-up: Following the procedure, patients are usually observed in a recovery area to monitor their vital signs. Pain medication may be prescribed to manage any discomfort. The patient will be advised on postoperative care, including activity restrictions and the use of sanitary pads instead of tampons.

5. Pathology Examination: The excised tissue is sent to a laboratory for pathological analysis. The examination helps determine the presence of precancerous or cancerous cells and provides valuable information for further treatment planning.

Results of Cervical Conization:

Outcomes of cervical conization can be quite variable, and it is necessary to understand what the results would mean. Given below, in short, will be possible outcomes:

Pathology Evaluation: The cone of cervical tissue is processed to a lab search for normal cells, precancerous cells (cervical dysplasia or CIN), or cancer cells.

Margin Status: The tissue margin is defined in the pathology report. Negative margins are indicative of the complete excision of abnormal tissue. Positive margins imply some abnormal tissue may remain.

• Normal Results: Indicates no precancerous or cancerous cells.

• Abnormal Results (CIN): Scored cervical intraepithelial neoplasia from 1 to 3 according to severity: 1 - mild; 2 - moderate; and 3 - severe; the grades would determine the required treatment or follow-up.

• Cancer Results: Further treatment is required for cancer-related results to be established.