LEEP
Loop Electrosurgical Excision Procedure
This is a procedure designed to remove a portion of the cervix under local anesthesia in the office. Most often this is done because of a change in the cervix called dysplasia. This means that the skin over the cervix is involved with pre-cancerous changes, the degree of severity being determined by how much of the thickness of the skin is involved. If the entire thickness is involved, the condition is known as carcinoma-in-situ. Minimal involvement is called mild dysplasia. The more severe the lesion, the less likely it is to resolve spontaneously. The LEEP procedure is used with increasing frequency to remove the diseased tissue in these cases of dysplasia. Other procedures that are sometimes used to treat these lesions are cryocautery (freezing of the cervix), cold knife conization, and hot cautery.
The instrument used to remove the tissue is a wire loop that cuts the tissue as electric current is passed through it. It causes very little thermal injury so microscopic evaluation of the tissue by the pathologist is feasible. The procedure is done on an examining table much like or identical to the exam tables used for regular gynecologic examinations. In preparation for the procedure, a grounding plate is applied to the leg and a local anesthetic with adrenalin (to reduce bleeding) is injected into the cervix. Once the cervix is anesthetized, the wire loop is directed toward the cervix. As it touches the cervix, the cutting current is applied and in a matter of about 5 seconds, the specimen is removed. After that, inspection is done and it is sometimes necessary to take an additional specimen of tissue. When the operator is satisfied that the abnormal area appears to be removed, a probe is used to cauterize the bleeding points in the operative bed. As a final precaution, the operative bed (the raw area where the specimen has been removed from) is sometimes treated with a coagulant solution to further seal the blood vessels.
The pathologist then analyzes the tissue and within 5 days a diagnosis should be forthcoming. Management beyond the LEEP procedure will depend on the pathologist’s report.
Complications related to the procedure are most often related to delayed bleeding or infection. If troublesome bleeding occurs, it is most often by the 10th day. Usually this is treated with another application of the coagulant solution or by electrocautery. You should notify your physician if you have heavy bleeding, severe abdominal pain, temp elevation to 100 degrees or more.
Your doctor will want to see you for a post-Op check-up then periodic visits thereafter, depending on the pathology report.