Laser miniconization procedure

Objective: To describe the outpatient procedure of minimal conization with free-hand guided high power density carbon dioxide laser for simultaneous diagnosis and treatment of CIN producing a one-piece tissue specimen for histological examination. Material and methods: 3100 non-pregnant patients with mild, moderate or severe dysplasia in pap smear, having colposcopically proved ectocervical lesions but without evidence of invasive carcinoma, or 85 pregnant patients with severe dysplasia in pap smear having extensive colposcopic signs of at least carcinoma in situ were admitted for this treatment. This outpatient procedure including cervical curettage is performed under local anesthesia to excise a one-piece 5 mm (during pregnancy 7 mm) deep minicone. Results: The degree of patient discomfort, bleeding complications, postoperative pain, infection or vaginal discharge were all minimal. The procedure was fast, causing minimal thermal damage of resection lines of the minicone specimen. Histopathological examination of the non-pregnant minicones revealed microinvasive or invasive carcinoma in 1.2%, the primary cure rate was 96.1%. During pregnancy, 13.3% malignancy was found. No unexpected sudden onset of invasive carcinoma was recorded during the 15-year follow-up and the cumulative risk of recurrence for all forms of CIN was 3.02%. Conclusions: The outpatient miniconization procedure, performed with a free-hand guided 60-W high power density CO2 laser is a reliable method for simultaneous diagnosis and treatment of CIN. Because of the paucity of complications, this procedure may also be appropriate during pregnancy. Copyright (C) 1996 International Federation of Gynecology and Obstetrics.