Radio wave conization as a method of cervical therapy. Conization of the cervix to eliminate precancerous conditions: should you agree to the procedure or not? How is radio wave conization of the cervix done?

Conization is prescribed to remove the affected cone-shaped area of the cervix. The removed tissues must be examined for the presence of cancer cells. After the procedure, the woman is regularly observed by the attending physician for 2 weeks. Radio wave conization of the cervix is performed using surgitron, a radio wave surgical generator.

When is the procedure scheduled?

Radio wave conization is exposure to electrodes with high-frequency electrical discharges. It differs from conventional electrocoagulation in that it has higher frequencies of current supply, prevents burns of nearby tissues, and reduces the time of exposure to the organ.

This procedure is indicated for patients who are suspected of developing grade 2 or 3 hyperplasia, the growth of cancer cells both inside and outside the cervix. For timely detection of pathological processes, it is recommended to visit a gynecologist annually for a standard examination.

Indications for radio wave conization:

Leukoplakia – keratinization of the mucous membrane.
Formation of polyps in the cervical area.
Erosive changes.
The presence of atypical cells in the smear.
Ectropion is an eversion of the mucous membrane into the vaginal area.
The presence of scars that appeared after various medical interventions, childbirth with ruptures, deformities.
After a morphological examination, dysplasia of 2 and 3 degrees was detected.
The presence of deeply altered areas of the epithelium, usually detected by colposcopy.
Relapse of dysplasia that occurred after laser vaporization or electrocoagulation.

The most common reason for this is the development of dysplasia. This disease is accompanied by damage to the mucous membrane and deeper layers of the cervix. The procedure is indicated for grade 2 dysplasia.

Contraindications

Contraindications include infectious diseases of the genitourinary system. Before conization, it is necessary to carry out a range of tests that will confirm or exclude an infectious component. In case of a positive result, antibacterial treatment is first carried out, then a repeat colposcopy. The possibility of safe conization is confirmed.

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Conization of the cervix is an operation that belongs to a low-surgical technique in gynecology. It consists of removing a cone-shaped section from the cervix and part of the cervical canal, hence the name of the operation. Conization is one of the methods for treating background and precancerous diseases of the cervix.

When is conization prescribed?

Conization is carried out when there are visible pathological areas on the cervix, as well as when dysplasia of the cervical epithelium is detected in smears that are taken from women annually during medical examinations.

The main conditions under which conization is carried out:

Presence of zones of altered epithelium during colposcopy.
Detection of atypical cells in smears.
Dysplasia of 2-3 degrees according to the results of a morphological study.
Erosion.
Leukoplakia.
Ectropion (eversion).
Cervical polyps.
Cicatricial deformities of the cervix after ruptures, injuries, previous manipulations of the cervix.
Relapse of dysplasia after electrocoagulation, laser vaporization, cryodestruction.

Still, the main reason why a woman is sent for conization is cytologically or histologically detected cervical dysplasia. Dysplasia is a violation of the normal differentiation of layers of multilayer epithelium. It is believed that dysplasia in most cases turns into cancer. In other classifications (especially abroad) you can find the term “cervical intraepithelial neoplasia” (CIN), in which three degrees are distinguished. Conization is carried out mainly for CIN II.

Purpose of the operation

Therefore, the main goal of the conization operation is to remove areas in which the mechanism of cancerous cell degeneration has already started and to prevent the development of cervical cancer. The operation performs two tasks: diagnosis and treatment.

An area of mucous membrane with pathological changes within the unchanged tissue is removed (healthy tissue within 5-7 mm is captured).
The removed section of the cervix is sent for pathohistological examination.
If the study excludes invasive cancer, and the edges of the removed cone do not contain dysplastic changes, the pathology is considered radically cured.
If, during the study, doubts arise about incomplete removal of the dysplasia zone or the presence of invasive cancer, conization is considered a diagnostic step. In this case, another more radical treatment is planned.

Preparing for surgery

Conization is planned immediately after the end of the next menstruation (on 1-2 dry days). This is done because in the first phase of the cycle, the level of estrogen increases, which promotes proliferation (increased restoration) of the epithelium and speedy healing.

You need to prepare in advance. When planning an operation, a gynecological examination, colposcopy, and smears are taken for microflora and cytology at least a month in advance.

An ultrasound of the pelvic organs and lymph nodes may be prescribed. If necessary, the doctor can take a biopsy from the most suspicious area.

If an inflammatory process in the vagina is detected, appropriate anti-inflammatory treatment is carried out until normal smear results are obtained.

2 weeks before the proposed operation, tests are prescribed:

General blood and urine tests.
Blood for syphilis.
Antibodies to HIV, viral hepatitis B, C.
Hemostasiogram.
Determination of blood group and Rh factor.
Fluorography (during the year).
Electrocardiogram.
Examination by a therapist.

Conization is not carried out:

In the presence of an inflammatory process in the vagina and cervix.
For biopsy-proven invasive cancer.
For acute infectious diseases.
When the boundaries of epithelial transformation are poorly defined.
If the boundaries of pathology go beyond the technical capabilities of treatment.
For decompensation of chronic diseases (heart failure, hypertension, diabetes, renal and liver failure).
Blood clotting disorders.

What are the types of conization?

Conizations are classified according to the physical factor by which the area of tissue is removed:

Knife.
Laser.
Cryoconization.
Electroconization.

By volume they are distinguished:

Economical conization (cone-shaped biopsy) - the size of the removed area is no more than 1-1.5 cm.
High conization – with removal of 2/3 or more of the length of the cervical canal.

Knife conization of the cervix

The area of the cervix is cut out with a regular scalpel. Until the 80s of the last century, knife conization was the main method of obtaining diagnostic material for detecting atypia in smears.

Currently performed very rarely due to the high incidence of complications(bleeding, perforation, formation of rough scars after surgery). Complications after knife conization are observed in 10% of cases (with other more modern methods - in 1-2%).

However, it is knife conization that makes it possible to obtain a drug for research of better quality than with laser or electric wave removal. Therefore, this type of conization is still used in a number of clinics.

Laser conization of the cervix

The desired area is removed using a high-intensity laser beam. The operation is low-traumatic, almost bloodless and painless.

Benefits of laser conization:

Flaws:

There is a risk of burns to surrounding healthy tissue.
In most cases, general anesthesia is required for maximum immobilization (the patient should not move).
The method is quite expensive.

Radio wave conization of the cervix

Other terms: electroconization, electric wave conization, diathermoelectroconization.

For these purposes, the Surgitron radio wave surgery apparatus is used. It consists of an electric generator and a set of various electrodes.

Tissue destruction is achieved by exposure to high-frequency alternating current.

An even more advanced method of radio wave conization is radiosurgical loop excision.

radio wave conization of the cervix

The desired area is cut out using a loop electrode specially designed for this purpose.

The doctor selects an electrode with a loop of the required size (the area to be removed should be 3-4 mm larger than the size of the pathological lesion). A high-frequency current is applied to the electrode. By rotating the loop electrode in a circle, a section of the neck is cut out to a depth of 5-8 mm.

Advantages of the method:

Can be performed under local anesthesia.
Damaged blood vessels are immediately coagulated - the risk of bleeding is minimal.
The temperature in the destruction zone does not exceed 45-55 degrees. There is no risk of burning surrounding healthy tissue.
Allows you to take an area of tissue for examination that is less damaged than with the laser method.
Very small percentage of complications.

Today this method of conization is the most common.

Video: radio wave conization of the cervix

Cryoconization

The pathological focus is destroyed by the freezing effect of nitric oxide. The method is painless and quite inexpensive. In our country it is currently practically not used. It is believed that it is not always possible to accurately calculate the power of the freezing factor, and also the main purpose of conization is not fulfilled - there is no tissue area left that can be examined.

How is conization surgery performed?

This operation does not require long-term hospital treatment. It can be carried out in a day hospital or a one-day hospital.

The entire operation takes no more than 20 minutes.

After operation

After conization, the patient remains in the ward for about 2 hours, then she can go home.

As a rule, aching pain in the lower abdomen (similar to menstruation) is noted for several days. Everyone will experience vaginal discharge after this procedure. But their number and timing may vary. There should be no heavy bleeding. Usually this is a clear serous discharge mixed with blood, or light brown, or spotting. The discharge may have an unpleasant odor.

For some, the cessation of discharge is noted after a week, for some it continues until the next menstruation. The first period after surgery may be heavier than usual.

Basic restrictions

The cervix after conization is an open wound. Therefore, as for healing any wound, it is necessary to minimize the impact on it. Namely:

Do not have vaginal intercourse for a month.
Do not use vaginal tampons.
Do not take a bath (wash in the shower).
Do not lift weights exceeding 3 kg.
Bathhouses and saunas are excluded.
Don't swim.
Avoid overheating.
Do not take drugs that prevent blood clotting (aspirin).

How does the cervix heal?

With an uncomplicated postoperative course, healing of the cervix occurs quite quickly. Approximately on the 7-10th day, the scab covering the wound comes off after coagulation of the vessels, and epithelization of the wound begins. Complete healing occurs by 3-4 months.

Usually at this time a re-examination by the gynecologist is carried out. If a woman doubts that something is wrong, she should consult a doctor earlier. Usually these points are always discussed, and the patient knows about suspicious symptoms X:

Heavy bleeding, like menstruation
Increased body temperature.
Continued discharge for more than 4 weeks or no decrease in discharge volume by the 3rd week.
Burning and itching in the vagina.
The appearance of pain in the lower abdomen some time after the operation (pain for several days immediately after conization is normal).
The appearance of discharge after a “dry” period.

As a rule, no additional effects on the cervix are required during this period. But in some cases, douching or suppositories may be prescribed.

A smear for cytology should be taken 3-4 months after the operation and subsequently every six months for 3 years. If atypical cells are not detected, after 3 years you can undergo a regular medical examination once a year.

Possible complications

Complications with modern types of conization are observed quite rarely (1-2%).

Bleeding.
Attachment of infection with the development of inflammation.
Cicatricial deformity of the cervix.
Miscarriage (spontaneous abortion and premature birth).
Endometriosis.
Menstrual irregularities.

Pregnancy after conization

For various pathological processes in the cervix in nulliparous women, or in women who are planning a second pregnancy, the most gentle methods should be chosen, if possible without disturbing the structure of the cervix (coagulation of erosion, polypectomy).

But if stage 2-3 dysplasia is histologically confirmed, conization is still inevitable in this case. In this case, modern methods are selected (laser and radio wave conization), the risk of complications in which is minimal.

It is advisable to plan a pregnancy after conization no earlier than a year after the operation.

As a rule, conization does not affect the ability to conceive. But sometimes, in cases of too extensive tissue resection, repeated conizations, or a complicated course, a narrowing of the cervical canal is possible due to the development of adhesions. Then the fertilization process will be difficult.

But the consequences of conization can have a negative impact on normal pregnancy and natural childbirth much more often than on conception. This is explained by the fact that the operation somewhat changes the structure of the cervix, it may shorten, and its elasticity may decrease. Therefore, women who have undergone conization may experience miscarriage to full term: the cervix simply cannot withstand the load and may dilate prematurely.

Natural delivery is possible in women who have undergone conization. But doctors must be completely sure that the cervix is elastic enough. In practice, delivery in such women is almost always carried out by cesarean section. Obstetricians are afraid of inadequate dilatation of the cervix during childbirth.

Firstly, this is a low-traumatic method that allows the patient to maintain her reproductive function.

Secondly, during the procedure, simultaneous coagulation (cauterization) of the bleeding areas occurs, which prevents the possibility of bleeding.

Thirdly, radio wave conization is characterized as a highly precise method of excision of affected tissue, therefore, even with a sufficient depth of exposure, changes in the remaining part of the cervix are minimal.

Experts have also noticed that the formation of scars after the radio wave conization procedure is much less common than after traditional methods of destruction.

Indications:

cervical dysplasia;
chronic recurrent erosion;
an area of altered epithelium discovered during colposcopy.

Contraindications include cervical cancer and inflammatory diseases of the pelvic organs in the acute stage.

Features of the method

Radio wave conization is carried out in the first days after menstrual bleeding, since this completely eliminates the possibility of a woman becoming pregnant and leaves a considerable period of time for healing (regeneration) of cervical tissue.

The duration of the procedure is no more than 15 minutes. The recovery period is approximately 2-3 weeks. During this time, it is not recommended to take a bath, do heavy physical work, or have intimacy.

Radio wave conization at Best Clinic is carried out by highly qualified specialists using modern equipment. The procedure is quite effective, safe and preferable for the treatment of ΙΙ and ΙΙΙ dysplasia. The method is not applied to young women of reproductive age with grade 1 dysplasia (without other changes in the cervix).

Find out which treatment method is right for you! Call the contact numbers listed on our website, or fill out a special form and make an appointment with a SMC Best Clinic specialist. Our doctors see you on weekdays and on weekends, so you can choose any time of visit that is convenient for you.

Modern gynecology is moving towards the use of less invasive and traumatic treatment methods. But there are pathological processes, the treatment of which requires the removal of altered tissues. This makes it possible to prevent further spread of the disease. In the treatment of cervical diseases, conservative methods are effective in the initial stages. Further therapy requires surgical approaches. The most modern is laser conization of the cervix. But this does not negate other ways of performing the procedure.

Features of the technique

Deep conization of the cervix involves the removal of a segment of the vaginal part of the organ in the shape of a cone, with its apex directed inside the cervical canal. This procedure may be performed for treatment or diagnostic purposes. In the latter case, the need for manipulation arises if there is a suspicion that the pathological process involves not only the surface of the epithelium, but also spreads into the thickness of its layers or to the initial part of the cervical canal.

But in both cases, the removed fragment is sent for histological examination to clarify the diagnosis. This is important for early detection. If cancer cells are detected in the material, then at the initial stage of the disease the cure reaches 97%.

If only dysplasia is present, all atypical cells are surgically removed, which also confirms a complete cure.

In what cases is conization necessary?

The operation is not a whim of the doctor. Indications for conization of the cervix are confirmed by preliminary histological examination and a series of tests.

Indications

2-3 degrees, confirmed histologically. The second degree affects the middle and lower layer of the epithelium, and the 3rd degree consists of an atypical change in all layers, including the area of the external pharynx.
Background diseases that may contribute to the development of cancer. For example, leukoplakia, ectropion.
when treatment by other means is ineffective and the disease progresses.
Scars in the area of the external pharynx that formed after traumatic childbirth, gynecological manipulations and operations. Areas of scar tissue can provoke inflammation, the formation of abnormal cells and cancer.
(genital warts) are viral in nature, but removal of the substrate for their reproduction leads to a cure.
The initial stage of cancer is in situ, when it does not affect the cervical canal.
Recurrence of squamous intraepithelial injury after previous treatment.

For diagnosed cervical cancer, conization is ineffective. Single cancer cells may persist and cause a recurrence of the disease. Therefore, cancer is an indication for removal of the uterus and additional chemotherapy and radiation treatment.

Contraindications

Cervical cancer is an absolute contraindication for surgery. The tumor requires a radical approach, the degree of intervention depends on the stage of the disease. In some cases, simultaneously with the removal of the uterus and cervix, it is necessary to remove the lymph nodes into which lymph flows from the affected organ, which means metastases spread.
Large size of the pathological lesion that is planned to be removed.
Infectious and inflammatory diseases of the genital organs. Radiosurgical and other types of conization form a wound on the cervix, which can become infected if pathogenic microorganisms actively multiply in the vagina. This will worsen healing and can lead to purulent complications. Therefore, before the operation, be sure to check the degree of cleanliness of the vagina. In grades 3-4, vaginal sanitation is carried out using antibacterial drugs, depending on the identified flora. Most often these are vaginal suppositories “Poliginax”, “Terzhinan”, for candidiasis “Gynofort”, “Ginezol”, against “Metronidazole”.
Pregnancy, lactation, unsteady menstrual cycle (lactation amenorrhea), uterine bleeding.
Pathology in the hemostatic system. Bleeding disorders can cause severe bleeding after or during surgery. Therefore, therapy is carried out aimed at improving coagulation and compensating for the condition, or another treatment method is selected.

Conization is carried out with caution in the following pathological conditions:

heart diseases;
arterial hypertension;
renal pathologies;
diabetes.

Methodology

The operation is performed in a hospital setting, but within one day. No further hospitalization is required. The doctor first talks with the woman, explains the essence of the technique and the possible consequences of conization of the cervix.

The advantage of the method is ease of implementation and low cost, with a small percentage of complications.

Depending on the clinic, different types of conization are used. The most commonly used method is the radio wave method. An alternative to this are knife and laser conization of the cervix.

Preparation

A preliminary examination in a antenatal clinic prepares for surgical intervention. General blood and urine tests are prescribed. Tests for HIV and syphilis are required.

A biochemical blood test and glucose reflect the general condition of the body. A coagulogram is necessary to assess the state of the blood coagulation system. In the presence of somatic and endocrine pathologies, a consultation with a therapist is necessary to determine the extent of the disorders.

A gynecological examination is combined with a smear on the flora. Colposcopy is performed before diagnosis. It is part of a comprehensive examination that determines the indications for conization.

Curettage of the cervical canal and biopsy of suspicious areas may not be performed if there are clear indications for conization. During the operation, a piece of tissue will be taken, the histological examination of which will replace other techniques. But sometimes in the process of making a diagnosis, the listed methods are first used.

The intervention is optimally carried out on days 5-7 of the cycle, when menstrual flow has already stopped. The perineal area must first be shaved.

How is cervical conization surgery performed?

The course of the operation does not differ much from the chosen technique. The woman lies down on the gynecological chair. The perineum is treated with an antiseptic solution. This is usually medical iodine, but if you are allergic to it, chlorhexidine or alcohol is used.

Stages of the operation: a) focus of the disease; b) determining the boundaries of the area to be removed; c) conization; d) cauterization of bleeding vessels

Speculums are inserted into the vagina. Instruments made of non-conductive material are often used to protect the doctor’s hands and the patient’s vaginal walls. The mirrors may have special channels for evacuating smoke that is formed during radio wave conization of the cervix. Discharge from the genital tract is removed with a swab containing an antiseptic.

A 2% solution of Lidocaine or its combination with epinephrine (Ultracaine) is used as anesthesia. The latter has a vasoconstrictor effect, which reduces the likelihood of bleeding. The anesthetic is injected using a syringe with a thin needle.

A tampon soaked in Lugol's solution is inserted into the vagina. It will allow us to further determine the boundaries of the pathological focus.

Most often the operation is performed with the Surgitron device. To establish the boundaries of the focus, they carry out. A passive electrode is placed under the buttocks or on the thigh. The shape of the active electrode and its size are selected depending on the lesion. The device is set to 35-55 W power. The optimal power is selected using the following method:

Loop sparking – excess power.
Sticking of the loop in the tissue is a lack of strength.

It is recommended to remove the entire pathological focus in one movement. But several approaches are allowed. In this case, the neck is fixed with bullet forceps beyond the border of the lesion. The electrode is installed 3-5 mm beyond the border of the changed tissue, moving 360° clockwise. The depth of the incision reaches 5-8 mm. The resulting sample is removed. The electrode is changed to a spherical one, which is used to cauterize bleeding vessels at a power of 60 W.

Most often, the operation is performed with the Surgitron device.

If a high degree of damage has been diagnosed or the epithelium of the cervical canal is involved in the pathological process, then curettage is indicated. Treatment of the cervix after conization is not required.

The whole procedure takes 15-20 minutes.

Possible complications

The postoperative period at the very beginning proceeds under the supervision of a doctor. Complications are rare, but they are possible. The first place is occupied by bleeding of varying severity. Discharge after conization of the cervix is normal for 2-3 weeks. But sometimes they can become severe and require medical attention. In 4-6% of cases, it becomes necessary to carry out local hemostatic procedures during the first hours after surgery:

apply a cotton-gauze swab;
use local chemical coagulation agents;
apply electrocoagulation.

Inflammatory complications are rare with proper preparation. Sometimes it is possible to develop a local inflammatory reaction that does not spread to the overlying parts of the reproductive system. The presence of fever after the procedure is an alarming symptom and requires medical attention.

A long-term consequence may be stenosis of the cervical canal or blockage of the opening of the external pharynx with scar tissue. This complication is observed in 1-5% of cases. The scar can deform the cervix. This condition is not dangerous for women who do not plan to become pregnant. But for those who plan to realize reproductive function, pregnancy and childbirth after conization of the cervix can be complicated. Often the consequences are developmental. If a scar forms on the cervix, this will disrupt the normal process of its opening during childbirth. Complications in this case will manifest themselves in the form of cervical ruptures. Therefore, the question of whether it is possible to give birth independently after conization of the cervix remains controversial.

Sometimes the isolated consequence can be spontaneous termination of pregnancy.

Features of various techniques

The choice of exposure method determines how the healing and recovery process proceeds after manipulation.

The knife method is considered obsolete. After it, bleeding and inflammatory changes occur more often. The operation is painful and is performed under general anesthesia. It requires hospitalization to exclude complications after anesthesia. Infectious complications also occurred more frequently. Recovery takes longer, and gross scar tissue changes are often observed.

Laser conization is performed under anesthesia to prevent accidental movement of the woman. The tissue cutting itself is painless. There is practically no bleeding, the vessels are immediately sealed with a laser. Scar changes and infectious complications are also excluded: microbes die under the influence of the laser. But expensive equipment and highly qualified specialists make the cost of laser treatment also high.

The most accessible is the radiosurgical method described above.

How is the rehabilitation period going?

In the first 2 hours after the procedure, the patient should lie down, after which she can go home. But a number of measures should be taken to prevent complications:

Sexual rest for 4 weeks after the procedure. This will reduce the risk of contact bleeding. The scab after conization of the cervix is a crust that covers the wound, but if handled roughly, it can separate and cause bleeding.
Limit thermal procedures; hot baths, saunas and steam baths, tanning, and warming up are prohibited. This increases local blood circulation and may also cause bleeding.
Do not lift weights, limit heavy physical labor.
Do not take aspirin or other anticoagulants.
Douching and vaginal tampons are prohibited. For hygienic purposes, use pads that are changed regularly.

Discharge is normal for 2-3 weeks. After 10 days they may intensify. This has to do with the way the scab comes off. But they should not have an unpleasant odor or foreign impurities.

After conization of the cervix, menstruation often begins on time. But the first menstruation may be more abundant, with clots.

Treatment in the postoperative period is required in case of complications such as infection. The choice of antibacterial drug depends on the pathogen. But more often it is a nonspecific flora.

Repeated conization can be carried out when a rough scar is formed after the first one. Changed tissues can become a site for the development of inflammation.

Pregnancy in the absence of scarring can occur naturally. But to decide whether it is possible to get pregnant after surgery, an examination is necessary. For those who want to preserve reproductive function, it is optimal to choose a laser treatment method.

Conization of the cervix is a gentle and less invasive method of treating female diseases. The pathological process occurring in the genital area is not always amenable to therapeutic treatment.

In these cases, surgical manipulation of the organ is required to remove the changed tissue and prevent the progression of the pathological process. Such a modern method is conization of the cervix, which is carried out through the vagina.

What is cervical conization surgery?

This is a cone-shaped removal of affected tissue from the cervical part of the organ and the cervical canal. The pathological focus is operated on, including healthy tissue.

The operation of conization of the cervix allows you to effectively treat pathology of the mucous membrane, while maintaining the possibility of pregnancy and bearing a healthy child.

For the outcome of the intervention to be positive, the patient must be aware of what cone-shaped resection is on the female genital organs and how it is performed. The operation is performed under local anesthesia and with minimal time.

Conization is carried out inpatiently, but hospitalization is not always necessary. A few hours later, after resection and examination by the attending physician, the patient is sent home.

When is conization prescribed?

The following indications are relevant for conization of the cervix:

dysplasia is a pathological change in the structure of an area of organ tissue, which is classified as a precancerous disease and requires mandatory treatment. Surgical treatment is necessary at any stage of pathology development. Conization of the cervix for grade 3 dysplasia is a mandatory surgical procedure;
presence of atypical cells in the upper epithelial layer of an organ tissue area (for cancer);
polyps and cystic formations inside the cervical canal;
scarring due to medical procedures or ruptures during childbirth;
migration of atypical cells into the cervical canal, especially with a rapidly growing pathological focus;
ectropion, organ leukoplakia;
cervical erosion, which, with various treatment methods, does not give a positive result and progresses

Purpose of the operation

The main goal is to remove the affected tissue. However, during conization, a fairly large volume of pathological material can be sent for histological examination. The laboratory determines the cause and gives a conclusion about the presence of cancer or chronic infection.

That is, the purpose of this manipulation is both therapeutic and diagnostic measures.

Repeated conization of the cervix is rarely performed, but can be performed in case of relapse after previous treatment of the pathological focus.

Preparing for surgery

Conization of the organ is carried out 3-5 days after menstruation. This is the optimal time during which the body recovers before the next cycle and the absence of pregnancy is guaranteed.

A month before conization, the preparation of the patient begins, when it is necessary to take the necessary tests and conduct the following studies:

colposcopy of the cervical uterus;
analysis of smears from the vagina and cervix for the presence of microflora and atypical cells;
ultrasound examination of the pelvic organs;
ECG of the heart;
fluorography of the lungs;
blood for hemoglobin, leukocytosis, ESR;
blood for clotting;
blood to determine the group and Rh factor;
blood biochemistry for hepatitis;
blood for AIDS and syphilis;
urine for general analysis.

What types of conization are there?

Depending on the type of pathological process, age and individual characteristics of the patient, conization is done using various techniques. Only the doctor decides which surgical intervention to perform.

There are several instrumental approaches for performing the operation:

Loop technique- This is the most common method of removing pathological formations on an organ, which is carried out using a cone-shaped loop and a diathermocoagulation device.
Knife technique- This is conization using a scalpel, which is currently not used due to numerous complications.

Electroconization

Electroconization of the cervix for dysplasia of any degree, it allows you to remove the pathological focus and stop the further development of the negative process;
Electrodiathermoconization of the cervix can be in the form of a deep procedure, using triangular attachments;
Diathermoelectroconization carried out using nozzles of shorter length, from one to three centimeters. It is important that when carrying out this method, gross deformation of the tissue does not occur in the future, and the operation does not have a negative effect on the woman’s reproductive function.

Laser conization of the cervix

When using a laser technique, the pathology is affected by a laser beam. Laser conization of the cervix provides a minimum of postoperative complications and the ability to regulate the volume of material taken for examination.

This conization technique has virtually no effect on planning the possibility of conceiving and bearing a child.

Radio wave technique is aimed at destroying a pathologically changed area of an organ by exposing tissue cells to high-frequency alternating current. In this case, for radio wave conization of the cervix, surgeons use the Surgitron apparatus with a set of various electrodes. The value of the technique lies in the fact that when tissue is dissected, blood vessels coagulate, which reduces the possibility of postoperative bleeding.
Radioconization of the cervix provides precise exposure to the pathological focus in the organ. The method is characterized by low pain and quick recovery after surgery. Complications such as wound infection are rare.
Radiosurgical conization eliminates burns and destruction of healthy organ tissue. After manipulation, the function for childbearing is completely preserved.

Cryoconization

Cryoconization is the use of liquid nitrogen to destroy an area of organ pathology by freezing. The method is relatively inexpensive and painless, since the organ is anesthetized by nitric oxide.

Now this type of operation is not used, since it is not possible to accurately calculate the power of the freezing factor’s effect on pathology. In addition, there is no possibility for histological examination of the area of the affected organ tissue.

How is conization surgery performed?

The availability of modern techniques for carrying out therapeutic and diagnostic manipulations on a woman’s reproductive organs makes it possible to perform surgery on the uterus in the shortest possible time. The operation is performed in a day hospital setting.

No special preparation is required before the manipulation. It is recommended to shave pubic hair and empty the bowels and bladder. Conization is carried out in the morning on an empty stomach. How quickly the operation takes place depends on the type of technique chosen by the doctor.

In general, resection lasts about half an hour.

The surgery is performed on a gynecological chair under local anesthesia with the use of sedatives or under short-term intravenous anesthesia.

The operation begins with a visual examination of the cervix on the mirrors and treating it with Lugol's solution or acetic acid.

The pathological segment, after applying one or another solution, changes its color.

After the tests, the organ is infiltrated with novocaine or lidocaine, followed by conization of the affected tissue area, about 5 mm thick.

The early postoperative period lasts two hours, during which the patient must remain in a day hospital. After this time, the woman is sent home.

After operation

Conization does not have a negative impact on a woman’s health, since modern equipment used for manipulation makes it quick and less painful.

Basically, the recovery period after conization proceeds without complications. Minor pain in the lower abdomen and discharge persist, lasting up to three weeks. The nature of the secretion may be bloody or brown.

During the recovery period, treatment after conization of the cervix is predominantly symptomatic.

After resection, a scab forms on the organ, which begins to be rejected and come out in the second week from the moment of surgery. During this time, the volume of discharge may increase.

Basic restrictions

In order for the postoperative period of cervical conization to go smoothly and without any complications in the patient’s condition, she must follow certain rules that imply restrictions for six weeks:

peace in intimate life;
exclusion of visiting the pool, saunas, baths and baths;
Limitation in lifting weights up to three kilograms;
eliminating tampons from use in personal hygiene;
exclusion from taking medications that help thin the blood (aspirin).

If after conization a fever appears or the general condition worsens, this is an indication for immediate consultation with a doctor.

How does the cervix heal?

Healing after conization of the cervix, if the recovery period goes smoothly, occurs quite quickly. Within one and a half to two weeks, the scab comes off, after which the wound epithelializes. Complete healing occurs within three to four months.

During this period, it is necessary to visit a doctor who will give recommendations on what the patient should know about her body after conization and how the cervix is healing.

These may be the following manifestations:

increased amount of bleeding for more than four weeks;
burning and itching in the vulva area;
pain in the abdominal area after a quiet period;
resumption of discharge after its cessation.

During this period, no therapeutic measures are carried out, but according to indications, taking into account the type of operation performed, the doctor may prescribe suppositories or douching.

How does the scab come off after conization?

After resection, a crust forms on the wound surface, which is a layer of dead cells.

What does a scab look like?

It can be grayish or yellow in color and have a soft consistency. The removal of the scab goes unnoticed in most women.

The crust covering the wound protects it from penetration of pathogenic microbes. A new layer of epithelial cells is formed under it, and when it is formed, the scab begins to come off. On average, its rejection begins to occur on the 5th or 7th day after conization.

In this case, the type of surgical intervention plays a role, when the period of removal of the crust can increase to 7–10 days and the possibility of an increase in the volume of bloody discharge.

Possible complications

Complications after cervical conization are rare, but possible.

It can be:

prolonged and heavy bleeding;
inflammatory processes in the genital area;
scar changes;
cervical organ insufficiency during pregnancy;
endometriosis.

Childbirth after conization of the cervix may be premature due to disturbances in the organ, that is, the weakness of its muscle layer.

Growing pregnancy, putting pressure on the incompetent cervical organ, causes prolapse of the fetus and premature opening of the birth canal.

In rare cases, stenosis of the cervical canal develops in the postoperative period, which leads to the impossibility of conception. Therefore, women planning a pregnancy are not recommended to undergo conization before conception, but to treat the disease conservatively.

Bleeding after conization

Uterine bleeding, as a consequence of conization of the cervix, is rare, in only 2% of cases, since the operation takes place in tissues in a place where large vessels do not anatomically pass through.

The cause of this complication may be technical errors during the operation, as well as disruption of the menstrual cycle. If damage to the vessel occurs, then the help of a doctor and the use of hemostatic agents are required.

Discharge

The organ can bleed for a long time, even up to four months. Healing occurs naturally, so this process cannot be accelerated. Discharge after conization of the cervix appears immediately after surgery.

After a week or a week and a half, when the scab begins to come off, the discharge is greater than normal and may stop seven days after the scab comes off, or may persist for a month after the operation. Sometimes the operated uterus secretes blood for up to three to four months.

Pain in the postoperative period

Recovery after conization occurs with minor pain, which is localized in the lower abdomen and is similar in nature to pain during menstruation.

This is a normal recovery process after surgery and does not cause any particular discomfort. The doctor, in this case, may prescribe painkillers.

The stomach stops hurting a few days after resection. But if the pain becomes more intense, a mandatory consultation with a doctor is necessary.

Pregnancy after conization

The availability of modern equipment allows surgical intervention to be performed with minimal complications. For patients planning conization of the cervix and pregnancy, resection is carried out using the most minimally invasive techniques, that is, radio wave or laser.

Pregnancy after conization generally proceeds normally. If postoperative insufficiency of the cervical canal appears, it is easily corrected by applying an obstetric pessary to the organ.

It consists of rings made of silicone or plastic, interconnected and having three sizes, which are installed at 20 and removed at 38 weeks.

Pregnancy after conization of the cervix is successfully carried to term, and the child is born naturally.

Restoration of the menstrual cycle

Surgery does not affect the menstrual cycle. Menstruation after conization of the cervix comes at the right time, but in abundance. In some cases, the doctor prescribes iron supplements to compensate for blood loss.

The risk of bleeding is associated with hormonal changes in the body caused by the operation, but their regularity remains.

Complete recovery of the organ after surgery occurs within three to four months, so the abundance of discharge during this period is functional in nature and does not require specific treatment.

In some cases, if hemoglobin drops and the color of the blood changes, symptomatic treatment is carried out.

Therefore, pregnancy after conization occurs after its final restoration. Hormonal imbalance with pathological changes in the menstrual cycle is observed in 20% of cases. In this case, such a contingent of patients needs medical therapy prescribed by a doctor.

Childbirth after cervical conization can be natural or by caesarean section. Cone-shaped resection does not have any effect on the development of the baby.

The tactics of labor management depend on the size of the postoperative scar on the organ:

If the seam is small, then under the strict supervision of a doctor, the woman gives birth herself or with the help of forceps.
If there is a large scar, may allow cesarean section.

But in any case, pregnancy and successful birth after resection are possible, both the first and subsequent ones.

Cost of the operation

The cost of laser or radio wave conization of the cervix in the same city, depending on the clinic, modern equipment and qualifications of doctors, will vary. Moscow differs in the medical services provided from other cities.

The cost of the operation in the capital will be from 40 to 50 thousand rubles , and in the regions from 8 to 15 thousand rubles.