LESSON 2: Procedures in Gynecological and Obstetrical Surgery

Section Ii: vaginal surgery

2-27

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2-27. CONIZATION AND BIOPSY OF THE CERVIX

a. General.

(1) This procedure is the removal of diseased cervical tissue to treat strictures of the cervix and chronic cervicitis. The conization may be performed either by scalpel resection and suturing or by the application of cutting electrosurgical current with an active electrode inserted into the cervical canal.

 

(2) Endometrial biopsy is done to determine the menstrual phase and carry out histological study of the endometrium. Scalpel conizations are done for diagnostic purposes, such as when the patient has a positive Papanicolaou (Pap) smear. Conization of the cervix may be done in some cases in which hysterectomy is indicated and in which benign disease of the cervix is present. It may also be done in those cases in which total hysterectomy is not feasible.

b. Operative Procedure.

(1) The posterior vaginal wall is retracted by a speculum and the anterior vaginal wall by lateral retractors. The outer portions of the cervix are grasped with a tenaculum, and the cervix is drawn toward the introitus; then the anterior speculum is removed. Cystic cervix may be treated with a needle electrode. Endometrial biopsy may be done. Bleeding points may be coagulated.

 

(2) For cauterization, the electrode is passed into the cervical canal, and the diseased membrane is removed. In patients with a positive Pap smear, the cervical cone is excised with a scalpel and bleeding controlled by coagulation and pressure.

 

(3) The cervical canal is cleansed with an antiseptic solution. If a wide conization is performed, the cervix may be sutured.

 

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