Cervical Cone Excision

Introduction

The cervical cone excision is the surgical procedure that uses to eliminate the intraepithelial neoplasia from the cervix of the uterus, which was previously documented by punch biopsy (cervical dysplasia). It is the surgical approach for the treatment mainly of high grade squamous intraepithelial lesion (HGSIL), such as CIN 2 or CIN 3 (Cervical Intraepithelial Neoplasia).
The cone excision of the cervix can be done with:
  • Cold knife
  • Laser excision
  • NETZ excision (Needle Excision of Transformation Zone) (Figure 1)
  • LOOP excision (Figure 2)
LLETZ: Large Loop Excision of Transformation Zone
LEEP:Loop Electrosurgical Excision Procedure

The main indications for cone excision are:
  • CIN2 & CIN3 (high grade intraepithelial lesions)
  • CIN1 (low grade intraepithelial lesion) which persist at least 2 years of follow-up
  • Adenocarcinoma in situ (AIS)
  • Micro-invasive squamous cervical carcinoma (FIGO stage Ia1)
  • Recurrence of cervical dysplasia (after previous successful treatment)
  • Residual disease (diagnosis of cervical lesion within 6 months from cone excision for cervical dysplasia)
  • Discrepancy between cytological and coloposcopic founding (diagnostic cone)
konoidis-ektomi1f
Figure 1
konoidis-ektomi2f
Figure 2

Treatment

LOOP excision is the most popular surgical approach for the treatment of cervical dysplasia. In case of superficial extra-cervical lesion (clear endocervical canal), a cone of 8mm depth using LLETZ-LOOP or LEEP technique is enough. However, for patients with no clear vision of the transformation zone (unsatisfactory colposcopy), or cervical dysplasia identified in the endocervical canal, a therapeutic cone of 12-15mm using cold knife, Laser excision, deep LOOP excision (cowboy hat) (Figure 3), or NETZ is the therapeutic option.

Τράχηλος μετά από επέμβαση LOOP (cowboy hat)
Figure 3. Deep LOOP excision of the cervix (cowboy hat)
Complications

The most often postoperative complications of cone excision are:
  • Intra-operative bleeding
  • Laceration of the urinary bladder 
  • Laceration of the colon
  • Postoperative bleeding (1-2%), within 48hours from the operation
Additionally, there are late complications after cone excision such as:
  • Wound (cervical) infection
  • Late (8th-12th postoperative day) bleeding (~9%)
  • Urinary or intestinal fistulas
  • Cervical stenosis (mainly after cold knife)

Share:

Share on facebook
Share on google
Share on twitter
Share on linkedin
Share on pinterest
Share on print
Share on email
Kalogiannidis doctor

IOANNIS Α. KALOGIANNIDIS MD, PhD

Associate Professor
Obstetrics Gynecology -
Gynecologic Oncology

SEE ALSO

gynecologist-testpap

Test PAP

PAP smear or test PAP is the collection of cell population from the cervix and the endocervical canal to identify cervical pathology, actually premalignant and malignant diseases.
papilloma-virus-hpv

HPV-DNA testing

Human Papilloma Virus (HPV) is related to cervical cancer in 99% of cases. Most often high risk subtypes concerning the malignant diseases of the female genital tract are the types 16 and 18.

Colposcopy

Colposcopy is the method for the further diagnostic approach of patients with cervical pathology, which was diagnosed using PAP smear or HPV-DNA testing.