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What is Cervical Excision?
Excision is the surgical removal or resection of a tissue fragment, a targeted surgical intervention aimed at removing altered areas for the purpose of diagnosis or treatment. In gynecology, cervical excision refers to the removal of an altered area within the transformation zone, where precancerous changes most frequently occur. This is a minimally invasive procedure aimed at removing pathological tissues to prevent the development of dysplasia or carcinoma. Excision not only allows for the elimination of atypical cells but also provides tissue for precise histological diagnosis. Depending on the method and the extent of the intervention, the procedure can be either therapeutic or diagnostic.
Types of Cervical Excision
There are several excision techniques, each with its own characteristics. The choice depends on the diagnosis, the tissue condition, the clinic's technical equipment, and individual factors, such as future pregnancy planning. The most common types of excision are: laser excision, radiofrequency excision (or radio-wave excision), loop electrosurgical excision procedure (LEEP), diathermoexcision, argon plasma technique, and excisional biopsy. Each method has its advantages and limitations, and the selection is made by the treating physician after a comprehensive diagnostic workup.
Laser Technique
Laser excision is a high-precision technique that utilizes a focused laser beam. It simultaneously cuts and coagulates the tissues, which minimizes blood loss and the risk of infection. The advantages of the laser include its non-contact nature, sterility, the absence of a severe thermal burn, and a low risk of scar formation. This method is particularly suitable for young women and those planning a future pregnancy, as the cervical structure is maximally preserved. The laser allows for work at a precisely defined depth and area, which is important when removing areas of Dysplasia Grade I–II (CIN I–II).
Radiofrequency Technique
Radiofrequency excision (or radio-wave cervical excision) is based on the effect of high-frequency radio waves, which heat the tissue and destroy the atypical cells. The method is non-contact, safe, and practically painless. Radio waves coagulate vessels, which prevents hemorrhage and promotes rapid healing. The procedure is performed on an outpatient basis, with minimal recovery time. Radiofrequency excision is widely used in women of reproductive age because it is gentle on the tissues and rarely leads to scarring.
Loop Excision
Loop electrosurgical excision procedure (LEEP) (also known as electroexcision) is performed using a special electrosurgical loop through which an electrical current passes. It allows the pathological tissue segment to be cut out and the vessels to be cauterized simultaneously. Cervical electroexcision is an effective, rapid, and accessible procedure, especially for CIN I–II (mild and moderate dysplasia). The loop technique is often used for diagnostic purposes, as the removed tissue is ideal for histological examination. Despite the use of electrical current, the risk of complications is minimal when the technique is adhered to. Electroexcision is a reliable and common method used in many clinics.
Diathermoexcision
Diathermoexcision is a type of electrosurgical intervention that uses more powerful currents and deeper thermal action. The method is effective for extensive lesions and recurrences of dysplasia. This form of electroexcision is not suitable for everyone, as it is associated with a greater risk of scar formation and cervical canal stenosis. However, it remains a reliable method for pronounced changes. With proper preparation and skilled rehabilitation, the probability of complications is reduced. It is often used in oncogynecology and for CIN III (severe dysplasia and pre-invasive cancer).
Excisional Biopsy
Excisional biopsy is a diagnostic procedure in which a small fragment of suspicious tissue is removed. The main goal is to obtain material for histology in cases of ambiguous results from colposcopy, Pap test (or Pap smear), or HPV diagnostics. Although the intervention may be minimal, it requires the same preparation as a full excision. When atypia or early cancer is detected, the biopsy allows for a quick decision regarding further treatment. Excisional biopsy is often performed using the radiofrequency or laser method.
Argon Plasma Excision
The argon plasma excision method is based on the use of ionized argon, which acts on the tissues without physical contact. The plasma effectively destroys pathological cells and coagulates vessels. Advantages include high precision, sterility, and minimal risk of burns. The method is currently used in a limited capacity due to the high cost of equipment and the need for specialized skills. Nevertheless, argon plasma technology is considered promising, especially for repeat interventions or in patients with impaired blood coagulation.
________________________________________
Preparation for Cervical Excision
Preparation begins with a medical examination, which may include the following tests: vaginal swab for flora and cytology, Pap test, colposcopy, tests for STIs (Sexually Transmitted Infections), HPV, HIV, syphilis, Hepatitis B and C, coagulogram (or coagulation profile), complete blood count (CBC) and biochemical blood analysis, and ECG (if necessary).
A few days before the procedure, it is recommended to refrain from sexual intercourse, not use vaginal suppositories, and avoid douching. The day before, it is advisable to exclude physical exertion and stress. If general anesthesia is planned, an anesthesiologist consultation is conducted.
________________________________________
How is Cervical Excision Performed?
The procedure is usually performed on an outpatient basis. The patient is placed in the gynecological stirrups (or lithotomy position), and the cervix is treated with antiseptics. The physician then performs the resection of the altered zone using the chosen method—laser, radiofrequency, electrical loop, etc. Anesthesia is usually local, but general anesthesia may be used if necessary. The entire manipulation takes from 10 to 30 minutes. After completion, the tissue is sent for histology, and the patient remains under observation for another 1–2 hours. Hospitalization is not required.
________________________________________
Indications and Contraindications
We highlight the main indications: cervical dysplasia (CIN I–III), a positive result for high-risk oncogenic HPV, suspicion of carcinoma in situ, a heterogeneous transformation zone, recurrent erosion, and pathological cytology following the Pap test results.
Contraindications: acute pelvic inflammatory disease (PID), pregnancy, menstruation, uncorrected blood coagulation disorders, and decompensated chronic diseases (e.g., diabetes mellitus). Excision may also be contraindicated in cases of uncontrolled hypertension (high arterial blood pressure), as it can affect the course of the procedure.
________________________________________
Advantages of Cervical Excision
Among the main advantages of this procedure are: precise removal of the affected tissues, the possibility of histological diagnosis, minimal risk of recurrence, gentle techniques for preserving fertility, rapid rehabilitation, and low invasiveness (or low traumaticity). Many women note that their experiences after cervical excision are often positive, especially when modern technologies are used.
________________________________________
Complications
Although the procedure is considered safe, the following are possible: spotting for up to 10–14 days, dull pain or cramping in the lower abdomen, menstrual cycle irregularity, scar formation and cervical canal stenosis, and infectious complications (rarely). It should also be noted that along with cervical canal scarring, dyspareunia (painful sexual intercourse) may also occur, especially if the scars significantly alter the structure of the cervix.
It is important to follow the doctor's recommendations, avoid sexual intercourse, visiting saunas (or baths), swimming in open water bodies, and physical exertion for at least 3–4 weeks. In case of alarming symptoms (heavy bleeding, fever, purulent discharge), it is necessary to contact a physician immediately.
________________________________________
Rehabilitation After Cervical Excision
Recovery usually takes 2–4 weeks. Bloody or serosanguinous discharge may occur during the first few days. It is necessary to: maintain intimate hygiene, avoid using tampons and douching, not lift heavy objects, abstain from sexual activity for a month, and visit the doctor for a follow-up examination. If necessary, healing suppositories, immunomodulators, or medications to correct the vaginal microflora are prescribed. Complete cervical healing occurs after 6–8 weeks.
________________________________________
Cost of Cervical Excision
The cost of the procedure depends on: the excision method (radiofrequency, laser, loop, etc.), the clinic's level, the materials and anesthesia used, and the need for hospitalization (in rare cases). On average, the price of cervical excision in Russia varies from 6,000 to 20,000 rubles. Radiofrequency and laser excision are more expensive but are also tolerated more easily. The exact cost depends on the region, the clinic's level, as well as the specifics of the procedure (e.g., additional tests, consultations, the cost of anesthesia). It is important to consider not only the price but also the physician's qualifications and the clinic's capabilities for postoperative management.
________________________________________
Cervical Excision: What's Important to Remember
Cervical excision is an important diagnostic and therapeutic procedure that helps not only remove pathological tissue areas but also prevent the development of oncological processes. Modern techniques make the intervention as gentle and safe as possible. The main things to remember are:
• The procedure is performed strictly according to indications, after a thorough examination.
• The choice of technique depends on medical parameters and reproductive plans.
• Recovery requires adherence to recommendations, but in most cases, it proceeds easily.
• Excision does not preclude the possibility of future pregnancy.
• It is important to have regular follow-ups with a gynecologist.
Only a specialist can select the optimal treatment method and ensure the safety of your health.
Excision is the surgical removal or resection of a tissue fragment, a targeted surgical intervention aimed at removing altered areas for the purpose of diagnosis or treatment. In gynecology, cervical excision refers to the removal of an altered area within the transformation zone, where precancerous changes most frequently occur. This is a minimally invasive procedure aimed at removing pathological tissues to prevent the development of dysplasia or carcinoma. Excision not only allows for the elimination of atypical cells but also provides tissue for precise histological diagnosis. Depending on the method and the extent of the intervention, the procedure can be either therapeutic or diagnostic.
Types of Cervical Excision
There are several excision techniques, each with its own characteristics. The choice depends on the diagnosis, the tissue condition, the clinic's technical equipment, and individual factors, such as future pregnancy planning. The most common types of excision are: laser excision, radiofrequency excision (or radio-wave excision), loop electrosurgical excision procedure (LEEP), diathermoexcision, argon plasma technique, and excisional biopsy. Each method has its advantages and limitations, and the selection is made by the treating physician after a comprehensive diagnostic workup.
Laser Technique
Laser excision is a high-precision technique that utilizes a focused laser beam. It simultaneously cuts and coagulates the tissues, which minimizes blood loss and the risk of infection. The advantages of the laser include its non-contact nature, sterility, the absence of a severe thermal burn, and a low risk of scar formation. This method is particularly suitable for young women and those planning a future pregnancy, as the cervical structure is maximally preserved. The laser allows for work at a precisely defined depth and area, which is important when removing areas of Dysplasia Grade I–II (CIN I–II).
Radiofrequency Technique
Radiofrequency excision (or radio-wave cervical excision) is based on the effect of high-frequency radio waves, which heat the tissue and destroy the atypical cells. The method is non-contact, safe, and practically painless. Radio waves coagulate vessels, which prevents hemorrhage and promotes rapid healing. The procedure is performed on an outpatient basis, with minimal recovery time. Radiofrequency excision is widely used in women of reproductive age because it is gentle on the tissues and rarely leads to scarring.
Loop Excision
Loop electrosurgical excision procedure (LEEP) (also known as electroexcision) is performed using a special electrosurgical loop through which an electrical current passes. It allows the pathological tissue segment to be cut out and the vessels to be cauterized simultaneously. Cervical electroexcision is an effective, rapid, and accessible procedure, especially for CIN I–II (mild and moderate dysplasia). The loop technique is often used for diagnostic purposes, as the removed tissue is ideal for histological examination. Despite the use of electrical current, the risk of complications is minimal when the technique is adhered to. Electroexcision is a reliable and common method used in many clinics.
Diathermoexcision
Diathermoexcision is a type of electrosurgical intervention that uses more powerful currents and deeper thermal action. The method is effective for extensive lesions and recurrences of dysplasia. This form of electroexcision is not suitable for everyone, as it is associated with a greater risk of scar formation and cervical canal stenosis. However, it remains a reliable method for pronounced changes. With proper preparation and skilled rehabilitation, the probability of complications is reduced. It is often used in oncogynecology and for CIN III (severe dysplasia and pre-invasive cancer).
Excisional Biopsy
Excisional biopsy is a diagnostic procedure in which a small fragment of suspicious tissue is removed. The main goal is to obtain material for histology in cases of ambiguous results from colposcopy, Pap test (or Pap smear), or HPV diagnostics. Although the intervention may be minimal, it requires the same preparation as a full excision. When atypia or early cancer is detected, the biopsy allows for a quick decision regarding further treatment. Excisional biopsy is often performed using the radiofrequency or laser method.
Argon Plasma Excision
The argon plasma excision method is based on the use of ionized argon, which acts on the tissues without physical contact. The plasma effectively destroys pathological cells and coagulates vessels. Advantages include high precision, sterility, and minimal risk of burns. The method is currently used in a limited capacity due to the high cost of equipment and the need for specialized skills. Nevertheless, argon plasma technology is considered promising, especially for repeat interventions or in patients with impaired blood coagulation.
________________________________________
Preparation for Cervical Excision
Preparation begins with a medical examination, which may include the following tests: vaginal swab for flora and cytology, Pap test, colposcopy, tests for STIs (Sexually Transmitted Infections), HPV, HIV, syphilis, Hepatitis B and C, coagulogram (or coagulation profile), complete blood count (CBC) and biochemical blood analysis, and ECG (if necessary).
A few days before the procedure, it is recommended to refrain from sexual intercourse, not use vaginal suppositories, and avoid douching. The day before, it is advisable to exclude physical exertion and stress. If general anesthesia is planned, an anesthesiologist consultation is conducted.
________________________________________
How is Cervical Excision Performed?
The procedure is usually performed on an outpatient basis. The patient is placed in the gynecological stirrups (or lithotomy position), and the cervix is treated with antiseptics. The physician then performs the resection of the altered zone using the chosen method—laser, radiofrequency, electrical loop, etc. Anesthesia is usually local, but general anesthesia may be used if necessary. The entire manipulation takes from 10 to 30 minutes. After completion, the tissue is sent for histology, and the patient remains under observation for another 1–2 hours. Hospitalization is not required.
________________________________________
Indications and Contraindications
We highlight the main indications: cervical dysplasia (CIN I–III), a positive result for high-risk oncogenic HPV, suspicion of carcinoma in situ, a heterogeneous transformation zone, recurrent erosion, and pathological cytology following the Pap test results.
Contraindications: acute pelvic inflammatory disease (PID), pregnancy, menstruation, uncorrected blood coagulation disorders, and decompensated chronic diseases (e.g., diabetes mellitus). Excision may also be contraindicated in cases of uncontrolled hypertension (high arterial blood pressure), as it can affect the course of the procedure.
________________________________________
Advantages of Cervical Excision
Among the main advantages of this procedure are: precise removal of the affected tissues, the possibility of histological diagnosis, minimal risk of recurrence, gentle techniques for preserving fertility, rapid rehabilitation, and low invasiveness (or low traumaticity). Many women note that their experiences after cervical excision are often positive, especially when modern technologies are used.
________________________________________
Complications
Although the procedure is considered safe, the following are possible: spotting for up to 10–14 days, dull pain or cramping in the lower abdomen, menstrual cycle irregularity, scar formation and cervical canal stenosis, and infectious complications (rarely). It should also be noted that along with cervical canal scarring, dyspareunia (painful sexual intercourse) may also occur, especially if the scars significantly alter the structure of the cervix.
It is important to follow the doctor's recommendations, avoid sexual intercourse, visiting saunas (or baths), swimming in open water bodies, and physical exertion for at least 3–4 weeks. In case of alarming symptoms (heavy bleeding, fever, purulent discharge), it is necessary to contact a physician immediately.
________________________________________
Rehabilitation After Cervical Excision
Recovery usually takes 2–4 weeks. Bloody or serosanguinous discharge may occur during the first few days. It is necessary to: maintain intimate hygiene, avoid using tampons and douching, not lift heavy objects, abstain from sexual activity for a month, and visit the doctor for a follow-up examination. If necessary, healing suppositories, immunomodulators, or medications to correct the vaginal microflora are prescribed. Complete cervical healing occurs after 6–8 weeks.
________________________________________
Cost of Cervical Excision
The cost of the procedure depends on: the excision method (radiofrequency, laser, loop, etc.), the clinic's level, the materials and anesthesia used, and the need for hospitalization (in rare cases). On average, the price of cervical excision in Russia varies from 6,000 to 20,000 rubles. Radiofrequency and laser excision are more expensive but are also tolerated more easily. The exact cost depends on the region, the clinic's level, as well as the specifics of the procedure (e.g., additional tests, consultations, the cost of anesthesia). It is important to consider not only the price but also the physician's qualifications and the clinic's capabilities for postoperative management.
________________________________________
Cervical Excision: What's Important to Remember
Cervical excision is an important diagnostic and therapeutic procedure that helps not only remove pathological tissue areas but also prevent the development of oncological processes. Modern techniques make the intervention as gentle and safe as possible. The main things to remember are:
• The procedure is performed strictly according to indications, after a thorough examination.
• The choice of technique depends on medical parameters and reproductive plans.
• Recovery requires adherence to recommendations, but in most cases, it proceeds easily.
• Excision does not preclude the possibility of future pregnancy.
• It is important to have regular follow-ups with a gynecologist.
Only a specialist can select the optimal treatment method and ensure the safety of your health.
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