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At least 19 recordsLinked to original sources
PubMed1983

[Conization and hysterectomy from the viewpoint of the surgically treated woman. Results of an inquiry among 814 conized and conized-hysterectomized women].

814 questionnaires of conized and conized-hysterectomized women were evaluated according to menstruation disorders, sexual behaviour, course of pregnancy, medical check-up, carcinophobia, mentality to the operation, pains caused by the operation, and changes of womanliness. 32 percent of the conized women (less than or equal to 45 years old) gave menstruation disorders, mostly hypermenorrhea and dysmenorrhea. Course of pregnancy was not influenced by the conization. Over 80 percent of the women (less than or equal to 45 and greater than 45 years old) said their sexual life were not changed by the conization, in difference to the conized-hysterectomized women: 56 percent (greater than 45 years old) and 69 percent (less than or equal to 45 years old). Half all women were more anxious to get cervical cancer after the conization. The conized women were significantly more to a medical check-up compare to conized-hysterectomized ones. Over 80 percent would like to repeat the conization before removing the uterus. Conized-hysterectomized women felt significantly more less according to womanliness compare to conized ones. 51 percent (less than or equal to 45 years old) and only 35 percent (greater than 45 years old) said no side effects after hysterectomy. Mostly the women complained of pains of the bladder, menses-like mastodynia, and labile circulatory system. There was no significant difference according the answers about abdominal or vaginal hysterectomy with or without adnexectomy.

Adult↗
PubMed1999

Cold-knife conization versus conization by the loop electrosurgical excision procedure: a randomized, prospective study.

OBJECTIVE: Our purpose was to compare the diagnostic ability and treatment efficacy of conization by the loop electrosurgical excision procedure with cold-knife conization. STUDY DESIGN: One hundred eighty women who required conization for diagnosis and treatment of cervical dysplasia or microinvasive cervical carcinoma were prospectively enrolled in a randomized clinical trial to receive either cold-knife conization or conization by the loop electrosurgical excision procedure. Conization complications, rate of lesion clearance, and therapeutic outcome were assessed for the 2 study groups. RESULTS: There were no statistically significant differences in the complication rate (P = 1.00), the rate of lesion clearance (P =.18), or the rate of disease recurrence (P =.13) between the 2 study groups. The mean follow-up was 11.2 months in the cold-knife conization group and 10.4 months in the loop-excision conization group. CONCLUSION: Cold-knife conization and loop-excision conization yield similar diagnostic and therapeutic results.

Adenocarcinoma↗
PubMed1993

A comparison between loop diathermy conization and cold-knife conization for management of cervical dysplasia associated with unsatisfactory colposcopy.

Eighty-six women with cervical dysplasia and unsatisfactory colposcopy were managed with excisional conization--43 with outpatient loop diathermy conization under local anesthesia and 43 matched controls with cold-knife conization as inpatients under general anesthesia. Both groups were similar in terms of age, parity, and severity of dyskaryosis on initial cytology, treatment success rates, and completeness of excision. However, loop diathermy conization was significantly quicker (2.8 +/- 2.9 min vs 14 +/- 18.6 min) and associated with less intraoperative blood loss (3.3 +/- 2.8 ml vs 79.1 +/- 74.6 ml) (P < 0.01) than cold-knife conization. Furthermore, the proportion of women with at least one complication was significantly less following loop (4.7%) than cold-knife conization (20.9%) (P < 0.05). We conclude that outpatient loop diathermy conization performed under local anesthesia is quicker and causes less intraoperative blood loss and immediate postoperative complications than cold-knife conization for management of cervical dysplasia associated with unsatisfactory colposcopy.

Adult↗
PubMed1984

CO2 laser conization versus conventional conization: a clinico-pathologic appraisal.

Two groups of patients recently underwent either laser or conventional conization at the University Women's Hospital in Bern, Switzerland. Of the total 49 patients treated, 25 underwent laser conization and 24 underwent conventional conization. All patients admitted to the study had cytologic, colposcopic, and/or histologic evidence for cervical intraepithelial neoplasia or chronic cervicitis resistant to conservative therapy. In the conventionally treated group, conization was performed with surgical scalpel, and hemostasis was achieved by Sturmdorff, Bonney, or Kraus sutures. In the laser-treated group, conization was performed by using the combination method of Dorsey and Grundsel. Blood loss was minimal in the laser-coned patients, compared to 119 ml blood loss in the conventionally coned patients. Hospitalization for the laser-treated group was 5.2 days in contrast to 7.0 days for the conventionally treated group. Postoperative bleeding and discharge were also considerably smaller or did not occur in the laser-treated group as compared to the conventionally treated group. With postoperative and long-term follow-up now under way, initial results indicate that laser conization, in comparison to conventional conization, also provides greater visibility of the squamocolumnar junction and a reduced incidence of cervical strictures. The results of this study suggest that the CO2 laser beam, properly and cautiously applied, is an efficacious surgical modality for the treatment of cervical preneoplastic disease.

Cervix Uteri↗
PubMed1991

CO 2 laser conization for cervical intraepithelial neoplasia: a comparison with cold knife conization during pregnancy.

Intraoperative and postoperative complications related to CO2 laser conization and cold knife conization were compared. From 1980 to 1984, 66 patients were hospitalized for cold knife conization. The mean operative time was 28.1 minutes, all patients had epidural anesthesia, and the mean time of admission was 6.8 days. Three percent of cases had infections, the mean intraoperative hemorrhage was 66 ml, and the rate of remaining foci of neoplasia was 18.2%. There were 116 patients hospitalized for CO2 laser conization from 1985 to 1987. The mean operative time was 15.6 minutes, 15.5% of patients had local anesthesia, and the mean time of admission was 0.6 days. No patients had infection or postoperative stenosis, the mean intraoperative hemorrhage was 75 ml, and 29.5% of patients had remaining foci of neoplasia. There was no significant difference in hemorrhage amounts at hysterectomy after conization using either method. In the 2 pregnant patients, CO2 laser conization could be performed safely and did not affect pregnancy or delivery. Thus in our experience, CO2 laser conization is more effective for clinical diagnosis and treating of cervical intraepithelial neoplasia.

Adult↗
PubMed1990

A randomized trial comparing two methods of cold knife conization with laser conization.

In a randomized study, 62 women were submitted to cold knife conization with application of Sturmdorf sutures, 60 to cold knife conization without sutures, and 61 to laser conization. Early hemorrhage occurred in 1.6, 13.3, and 6.6% of women, respectively (P less than .05), and late hemorrhage in 15.3, 3.6, and 11.7%, respectively. Considering early and late hemorrhage together, there was no significant difference among the three treatment groups. Dysmenorrhea tended to be more common after application of Sturmdorf sutures, as it was reported by 27.8, 13.2, and 14.3% of patients, respectively, but the difference was not statistically significant. Dysmenorrhea occurred in 13% of the cases with a cone height of 20 mm or less and in 26% of the cases with a cone height greater than 20 mm (P less than .05). Endocervical cells were present significantly more often after sampling with a cytobrush than with a cotton swab (P less than .0001), whereas the method of conization had no influence. In smears obtained with a cytobrush, endocervical cells were present in 88.0, 84.9, and 82.5% of the cases; in smears obtained with a cotton swab, endocervical cells were present in 46.6, 57.7, and 54.5%, respectively. We conclude that cold knife conization without Sturmdorf sutures is about equal to laser conization in overall complications, but the laser is preferable for outpatient treatment because of a lower frequency of early hemorrhage. Sturmdorf sutures should be avoided. Smears at follow-up should be taken with a cytobrush and a wooden spatula.

Adult↗
PubMed1989

[A comparison between CO2 laser conization and cold knife conization in clinical diagnosis of cervical intraepithelial neoplasia].

Intraoperative and postoperative complications related to CO2 laser conization and cold knife conization were compared. From 1980 to 1984 66 patients were hospitalized for cold knife conization, the mean operative time was 28.1 minutes, all patients had epidural anesthesia, and the mean time of admission was 6.8 days. Three percent of cases had infections, the mean intraoperative hemorrhage was 75 ml, and the rate of remaining foci of neoplasia was 18.2%. Meanwhile there were 116 patients hospitalized for CO2 laser conization from 1985 to 1987. The mean operative time was 15.6 minutes, 15.5% of cases had local anesthesia, the mean time of admission was 0.6 days. Zero percent of cases had infections, 0% of cases had postoperative cervical stenosis, the mean intraoperative hemorrhage was 75 ml, and 29.5% of cases had remaining foci of neoplasia. There was no significant difference in hemorrhage amounts at hysterectomy following conization either method. Thus, in our experience, CO2 laser conization is more effective for clinical diagnosis and treating of cervical intraepithelial neoplasia.

Adult↗
PubMed1994

Comparison of office loop electrosurgical conization and cold knife conization.

A group of 98 patients with abnormal Papanicolaou smears underwent cold knife conization or loop electrosurgical conization after colposcopic examination and biopsy. Average duration of surgery, intraoperative bleeding, rate of complications, and cost of the procedure were significantly less for the electrosurgical conization group. We conclude that this procedure may be performed in the office in place of hospital cold knife conization for the diagnosis and treatment of cervical intraepithelial neoplasia.

Ambulatory Surgical Procedures↗
PubMed1992

Outpatient loop diathermy conization as an alternative to inpatient knife conization of the cervix.

A knife cone biopsy of the cervix is usually performed as an inpatient procedure under general anesthesia and is associated with significant morbidity. Loop diathermy conization was performed under local anesthesia on colposcopy outpatients as an alternative to knife conization. In 33 consecutive patients studied the procedure was well tolerated, there were no operative complications, and a satisfactory specimen for histologic examination was obtained in every case. One case of unsuspected invasive cancer and two of suspected microinvasive cancer were diagnosed. The diagnosis of cervical precancer was made in 24 (73%) of the cases. The introduction of outpatient loop diathermy conization of the cervix instead of knife conization would decrease hospitalization costs, avoid the need for general anesthesia and potentially reduce short-term patient morbidity.

Adult↗
PubMed1982

Laser conization versus cold knife conization.

This prospective, randomized study compares, for the first time, measured blood loss at conization and within 24 hours after using either the cold knife technique or the carbon dioxide laser scalpel. One hundred and ten consecutive patients were evaluated. The median blood loss in the laser group of 55 patients was 4.6 milliliters at, and within, 24 hours after operation compared with 30.1 milliliters in the cold knife group of 55 patients. More important, however, is that the corresponding figures for the range of bleeding were 0.4 to 155.4 milliliters and 5.6 to 1,570.9 milliliters, respectively. The incidence rate for bleeding complications requiring surgical intervention was 1.8 per cet for the laser group and 14.6 per cent for the cold knife group. This difference was statistically significant, p less than 0.015--Fischer's exact test. Conization for treatment of premalignant changes of the cervix uteri will probably remain the treatment of choice for some time to come. It is our opinion that, in the future, laser conization will replace cold knife conization.

Carcinoma in Situ↗
PubMed1988

[Conservative treatment of grade 3 intra-epithelial cervical neoplasms. Comparative study of CO2 laser vaporization, laser conization and cold scalpel conization].

Carbon dioxide laser was used in 79% of the 141 conservative treatments carried out for grade 3 cervical intra-epithelial neoplasia (CIN III) between the years 1982 and 1986 (41% vaporized and 38% coned out by using the laser as against 21% that were treated by scalpel conisation. The mean age of the women treated in this way by the laser was low (28.5 years of age and 32.5 years as against 38.1). Their parity was also low (0.8 and 1.2 as against 2.2). The lesions were very often spread out on the ectocervix and sometimes going into the vagina (26 and 9% as against 26%) or associated with koilocytosis (65.5 and 47.2% as against 41.3%). In one out of two cases vaporisation of the lesion is contra-indicated and the three diagnostic methods that are used (an ecto and endocervical smear, colposcopy and multiple directed small biopsies) do not make it certain that there is no underlying invasion of the tissues. Vaporisation and conisation are easily carried out under colposcopic control and are associated with widespread lesions at the squamo-columnar junction. These treatments sometimes have to be repeated; then they give a cure rate of 92-96% as against 96%. They are more reliable than conventional surgery for widespread lesions and they do make it possible to keep to the morphology of the cervix and thus make it possible for the cervix that is treated to behave more physiologically. It is also much easier and more reliable in these cases to carry out follow-up for carcinoma. This follow-up should be carried out on two occasions. The triple diagnostic method should be carried out again at the third month (2 smears, colposcopy and colposcopically directed small biopsies). This makes it possible to diagnose and treat early the cases where there has been failure of the original treatment. Then ecto and endocervical smears should be repeated at 3-monthly intervals, then at 6-monthly intervals and finally annually to screen for recurrences of these neoplastic conditions, and for koilocytosis which sometimes repeat themselves in an extensive manner.

Adult↗
PubMed1994

A randomized prospective study comparing three techniques of conization: cold knife, laser, and LEEP.

Three different techniques of cervical excision, cold knife conization, laser conization, and loop electrosurgical excisional procedure (LEEP) were prospectively compared with respect to treatment reliability, effectiveness, and safety. One hundred ten women with CIN1-2 and the squamnocolumnar junction not seen or CIN3 at the original diagnosis were randomized to treatment with cold knife conization (n = 37), laser conization (n = 37), or LEEP (n = 36). All three treatments were performed with local anesthesia on an outpatient basis. The mean age, histologic features (original and histology of the conization), endocervical involvement, and ectocervical extension were similar in the three groups. Blood loss and operating time were less (P < 0.01) in the LEEP group (5.4 cc of mean blood loss and 5.4 min mean duration time) than in the two other groups (16.2 cc and 14.0 min for cold knife conization, 21.5 cc and 15.6 min for laser conization). Volumes of the cones were evaluated: LEEP cones and laser cones were smaller than the cold knife cones (P < 0.001). During the pathological review of the conization, the major problem was difficulty in evaluating the lesion and its margins due to the coagulation induced by the laser or the LEEP. This alteration was present in 53% of the LEEP conization specimens and in 51% of the laser conization specimens. In the majority of the cases the coagulation was mild, but in one case (LEEP group) and in two cases (laser group) the conization was totally altered by the coagulation, and in 31% of all the LEEP conizations and 38% of all the laser conizations, evaluation of the entire margin was not possible due to coagulation of the tissue. During postoperative follow-up, the number of complications was the same in the three groups (two episodes of post-operative bleeding in each of the three groups). Two months after the treatment the cervix was evaluated: the os was diminished in the cold knife group compared to the two other groups and as a result, the squamnocolumnar junction was not seen in entirety in 50% of cold knife cases, in 19% of LEEP cases, and in 20% of laser cases. These results suggest that in our hands: (1) laser conization is relatively costly and time consuming and alters the tissues significantly, and (2) the choice between cold knife and LEEP is more difficult--cold knife gives a sample adequate for histological evaluation (including evaluation of the margins), while the LEEP procedure is technically easier and less time consuming but sometimes induces electrocautery artifact so that evaluation of the margins is not possible.

Adult↗
PubMed1995

The role of endocervical curettage at cervical conization for high-grade dysplasia.

OBJECTIVE: To quantify the risk of invasive cancer above the location where the conization specimen was taken in patients with an endocervical curettage (ECC) positive for dysplasia at conization for high-grade cervical intraepithelial neoplasia (CIN), and to determine if any pathologic features may influence this risk. METHODS: The charts of 104 patients who underwent cervical conization for high-grade dysplasia followed by repeat conization or hysterectomy at Los Angeles County + University of Southern California Women's Hospital between January 1986 and December 1992 were reviewed retrospectively. Patients with invasive cancer or glandular dysplasia on the initial conization were excluded. The ECC performed immediately after conization biopsy (conization ECC) was benign in 63 patients and contained dysplasia in 41. All available conization ECC specimens that contained dysplasia were evaluated for volume of dysplasia and degree of cytologic atypia. Fisher exact test was used for statistical comparison between and within groups. RESULTS: Invasive cancer was not present in any patients in the benign ECC group but was present in nine (22%) patients in the dysplasia group (P < .0001); five of these patients had microinvasion (no more than 3 mm of stromal invasion and no lymph-vascular space involvement) and four had frank invasion. Comparison of patients with involved endocervical margins revealed that none of 37 patients in the benign ECC group versus eight of 27 patients in the dysplasia group had invasive cancer (P < .0005). All patients with invasion were 35 years or older and all patients with frank invasion were 50 years or older. Neither volume nor cytologic grade of dysplasia in the ECC was predictive of invasion in the residual cervix. CONCLUSIONS: An ECC at conization positive for dysplasia is an important predictor of invasion in the residual cervix of patients whose conization reveals high-grade intraepithelial neoplasia and should be routinely performed. Women 50 years or older with both a positive endocervical margin and conization ECC should undergo repeat conization before further therapy. Women under 50 years of age should undergo repeat conization if fertility is not desired; otherwise, close follow-up is necessary to exclude the presence of an invasive lesion in the residual cervix.

Adult↗
PubMed1979

Pregnancy complications following conization of the uterine cervix (II).

The effect of conization upon the course of pregnancy and the fertility has been evaluated. 44 women had a total of 66 pregnancies following conization. These 44 women were compared with an age-matched group of non-conized women, as well as with a group of non-conized women matched for both age and parity. There were more smokers among conized than among non-conized women. All other descriptive variables were found to be without significant differences between the groups compared. There was no significant difference in the frequency of spontaneous and induced abortion, prematurity or cesarean section between conized and non-conized women. The second stage of labor was found to be protracted in conized women. Fertility judged by the "latent period"--the time elapsed from the couple started sexual intercourse without use of contraception to the present pregnancy--showed no difference between conized and non-conized women. We conclude that although a greater number of patients is necessary to permit definite conclusions concerning the risk of pregnancy and delivery complications in conized women, it is of special interest that the present study did not demonstrate an increased risk of spontaneous abortion nor of prematurity.

Abortion, Spontaneous↗
PubMed1997

Risk of residual invasive disease in women with microinvasive squamous cancer in a conization specimen.

OBJECTIVE: To quantify the risk of residual invasion when cervical conization reveals microinvasive squamous carcinoma and to determine whether any factors affect this risk. METHODS: We reviewed the charts and histopathology slides of 87 women who underwent a conization that contained microinvasive squamous carcinoma, followed by either a repeat conization or hysterectomy. Depth of invasion, number of invasive foci, and status of the internal margin and post-conization endocervical curettage (ECC) were assessed. The findings were correlated with the presence of residual invasion. RESULTS: Significant predictors of residual invasion included status of the internal margin (residual invasion present in 22% of women with an involved margin versus 3% with a negative margin; P < .03) and the combined status of the internal margin and post-conization ECC (residual invasion in 4% of patients if both negative, 13% if one positive, and 33% if both positive; P < .015). Depth of invasion and number of invasive foci in the conization specimen were not significant. The power of this study to detect a 25% difference in the risk of residual invasion was 73% for depth of invasion and 75% for number of invasive foci. CONCLUSION: Women with microinvasive squamous carcinoma in a conization specimen in which both the internal conization margin and post-conization ECC are negative have a low risk of residual invasion and are candidates for follow-up or simple hysterectomy. If either the internal margin or the post-conization ECC contains dysplasia or carcinoma, the risk of residual invasion is high and warrants repeat conization before definitive treatment planning.

Carcinoma, Squamous Cell↗