Cold Knife Conization

Occasionally, I will encounter someone with a lesion I have difficulty seeing microscopically or a lesion that is very suspicious for cancer on biopsy that needs a little more than LEEP. Since the LEEP procedure uses electrical current to do the cutting, the edges of thespecimen are charred when the pathologist looks at it under his microscope. If he sees abnormal tissue on the edge of his specimen, it might remain on the cervix. I cauterize the bed of the LEEP to destroy any remnants of dysplasia that might remain. A cold knife conization utilizes a scalpel to remove the abnormal tissue and gives clear indication to me as to whether the abnormal cells are completely removed or not. Since this is a hospital outpatient procedure, only select patients are required or recommended to undergo a cold knife cone. Occasionally even patients with lesions that have been recommended cold knife cone could potentially undergo LEEP as an alternative. The cone specimen is generally a little larger than the LEEP specimen. The cervix is cauterized, and packed to reduce the risk of post operative bleeding which very rarely occurs.

The pathologist renders his diagnosis and further treatment and screening is outlined. Postoperative instructions are the same as for LEEP procedures and include avoiding tampons and sexual intercourse until all bleeding and discharge stop…around 3 weeks. I generally see these patients back in the office a week following t heprocedure.