Methods of conization of the cervix. Conization of the cervix - everything about the procedure, rehabilitation, the possibility of natural pregnancy and childbirth after Radio wave conization of the cervix bleeding

More and more new methods are being developed for the treatment of gynecological diseases. One of these was radio wave conization of the cervix. What it is and how such manipulation is carried out is described in this material.

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Definition

In many cases, a procedure called radioconization of the cervix is ​​prescribed. What is it and how is it carried out? Conization is the process of removing a piece of tissue from the cervix. The intervention received this name because the removed fragment has a cone-shaped shape. An intervention is performed to eliminate the affected area of ​​tissue to prevent further spread of the pathology.

What changes when it comes to radio wave conization? In essence, nothing. The same cone-shaped section of tissue is removed, but its excision is carried out using a radio wave knife. This type of surgery has become widespread due to the fact that the operation process is quite simple and it is easily tolerated. The wound surface is minimal, as is the depth of treatment, no large scar is formed. And due to the fact that the method is practically non-contact, the risk of infection during the intervention and the development of infection or inflammation is extremely low.

The radioknife works on the principle of coagulation. It evaporates water from the cells, they disintegrate, and this is how the “cut” is formed. In this case, the vessels are immediately coagulated by radio waves.

When is it held?

What are the indications for such an intervention? In fact, we are talking here about indications for conization of the cervix in one way or another. Given these indications, there is no difference in how exactly to perform conization (with a radio knife, a loop, etc.). So, conization is prescribed for the following conditions:

1. Severe and/or recurrent erosions;
2. Detection of atypical cells in small quantities;
3. Cervical dysplasia of the second or third degree, as determined by morphological examination;
4. Advanced leukoplakia due to the risk of degeneration into oncology;
5. Recurrent dysplasia or erosion after cauterization;
6. The presence of significant scars as a result of injury or previous surgical interventions;
7. Polyps on the cervix, especially multiple and recurrent ones;
8. Ectropion (eversion of the cervical canal mucosa);
9. The presence of zones of altered epithelium, when the nature of the changes cannot be determined (this is done just in case, in order to avoid the potential development of an oncological process).

Such indications most often require a non-urgent intervention, so the patient has time to undergo an examination and thoroughly prepare for the intervention.

Contraindications

When can conization not be carried out and what should be done in this case? This procedure has quite a few contraindications, but they are general in nature and apply to any gynecological intervention. Radioconization cannot be performed in the following cases:

1. The presence of an inflammatory or infectious process in the organs of the reproductive system;
2. The presence of a general systemic inflammatory disease, including a cold;
3. The presence of oncological processes in the reproductive system or suspicion of them;
4. Reduced general immunity of the body or local tissue immunity (for example, after operations or serious illnesses);
5. Uterine bleeding of unknown origin.

There may be other individual contraindications. But most often they are relative in nature, since with them intervention can be carried out, it is enough just to carry out competent medical preparation for it. Thus, preparation for conization will include treating inflammatory processes or strengthening the immune system.

Preparation

In order for radiosurgical treatment of the cervix to not have negative consequences for the patient, it is necessary to find out whether she has contraindications to treatment in this way. For this purpose, a number of studies are prescribed. Among them are:

1. Vaginal smear to determine the presence of pathogenic microflora;
2. A coagulogram is recommended to determine blood clotting;
3. General and biochemical blood tests are necessary to identify hidden inflammatory processes in the body;
4. Ultrasound examination of the pelvic organs is carried out to identify additional pathologies;
5. Examination by a gynecologist and colposcopy are carried out for the same purposes;
6. If an oncological process is suspected, it is necessary to submit tissue for biopsy and cytology.

Immediately two days before surgery, it is important to carefully observe hygiene, avoid sexual contact and not use chemicals for washing. Also, in consultation with your doctor, stop taking medications with vaginal administration. Do not use tampons.

Progress of the procedure

The procedure is performed on an outpatient basis and takes 15-20 minutes, during which the patient is in the gynecological chair. Performed under local anesthesia. First, the doctor installs a dilator on the vagina and sanitizes it and the cervix. After this, a section of tissue is excised using a radio knife, and after that the vessels are coagulated.

After this, sanitation is carried out again, the expanders are removed. The tissue may be sent for biopsy.

Recovery

The recovery period lasts about one and a half months. During this time, your doctor may prescribe antibiotics if there is a risk of infection or inflammation, but usually there is no such risk. To ensure that the intervention does not have unpleasant consequences for the woman’s body, it is recommended to follow these instructions:

1. Avoid sexual activity for the entire period of the recovery period;
2. Do not overheat - do not visit solariums, beaches, saunas, do not steam in the bathroom;
3. Do not swim in natural bodies of water;
4. Maintain good hygiene, but only use the shower;
5. Do not use tampons, vaginal suppositories and medications with vaginal administration, including creams and gels.

During the first few days, it is normal to have a heavy discharge with some blood. Also on the first day you may feel slight pain in the lower abdomen. But if this condition does not go away within three or more days after the intervention, then you need to consult a doctor, as this may be a sign of an infectious process.

Complications

This operation, performed using the radio wave method, has a minimum of complications and is tolerated quite easily. Usually, it is not accompanied by the formation of adhesions in the cervical canal, and a large scar is not formed. Theoretically, there may be a possibility of bleeding, but it is minimal, since even large vessels are coagulated during the manipulation.

The likelihood of infection by certain bacteria and viruses is also minimal, since the intervention is performed almost entirely using a non-contact method. Such surgery is the most favorable from the point of view of planning a further pregnancy, since other methods have such a complication as a slight decrease in the likelihood of pregnancy occurring naturally (for one reason or another).

Pregnancy

Radio wave conization of the cervix is ​​one of the most preferred methods of exposure from the point of view of further pregnancy. Such an operation does not lead to the formation of a scar, or it is formed very small, due to which there are no further significant obstacles to conception. Whereas when performing the procedure using other methods, the scar may turn out to be so large that its tissue will block the lumen of the cervical canal for sperm.

In most cases, pregnancy is successful. Although in some cases it may be necessary to suture the cervix or install a pessary on it in order to prevent its premature excessive dilatation. This helps avoid preterm birth if there is such a risk, although there is not always such a risk.

The birth process itself after conization of the cervix most often occurs by caesarean section (although in rare cases natural birth is also possible). As a rule, no significant complications arise during childbirth; they proceed normally for both mother and child.

Price

The cost of such a procedure is generally higher than the price of conization using another method, for example, loop using current. However, it is worth considering that such a procedure is easier to tolerate, and after it there is a shorter recovery period, during which the woman feels relatively normal. In addition, from the point of view of further pregnancy, this method is much more preferable than all other methods.

The cost of radio wave conization of the cervix by city is shown in the table below.

The cost depends on many factors. This includes the doctor’s work, the cost of drugs and consumables; some clinics also indicate the price immediately, taking into account all the necessary preliminary studies. For this reason, the price spread can be quite significant.

Conclusion and Conclusion

Conization of the cervix is ​​a relatively serious procedure, therefore it is prescribed only if there are serious indications, which means it cannot be refused. And if a woman plans to have children in the future, then it is worth choosing the radio wave method, since, although it is a little more expensive, it is nevertheless more preferable from the point of view of future pregnancy. But even if pregnancy is not planned in the future, this method is still the best choice, since such manipulation is easier to tolerate and the body recovers faster.

Conization of the cervix is ​​performed only in extreme cases when drug therapy is impossible or does not produce results. This type of intervention helps prevent further progress of pathological changes in the tissues of the cervix. The feasibility of the operation is determined by the doctor after a series of laboratory and instrumental studies.

What is conization of the cervix

Conization of the cervix is ​​a cone-shaped excision of part of the cervix and cervical canal. Surgery is necessary to eliminate precancerous conditions. During conization, mainly the tissue of the cervix is ​​removed; the cervical canal is affected to a lesser extent. The pathologically changed epithelium is immediately sent to the laboratory after excision to determine whether atypical cells are present. This is necessary to determine the tactics of further treatment.

Conization of the cervix is ​​used for precancerous conditions

Conization is a traumatic method of intervention for the female reproductive system. This method is used after conservative therapy, correction of immunity and hormonal levels. The part of the cervix removed after conization is restored within several months, but the shape of the organ changes slightly.

An interesting fact: nowadays, this type of surgical intervention is used less and less, since many women, especially young women, have problems conceiving and bearing a fetus. Instead, more gentle techniques are used to help maintain the integrity of the cervical canal.

What is conization of the cervix - video

Indications for intervention

The operation is indicated for advanced grade 2-3 dysplasia, which is detected during a pincer biopsy or when examining tissue scrapings from the cervical canal. Conization is also used for cervical erosions, endometrial polyps, and in the presence of cicatricial deformities.

Additional indications:

• endometrial hyperplasia;
• cervical eversion;
• recurrence of dysplasia;
• postpartum scars on the cervix;
• initial stage of cancer.

This type of intervention allows you to remove altered tissue, thereby preventing the progression of the disease and the possibility of the pathology turning into cancer.

Contraindications

The operation is not performed in the presence of sexually transmitted diseases and inflammatory processes in the vagina. Before intervention, it is important to eliminate all infections, otherwise there is a high risk of relapse and complications after conization. Only after thorough sanitation of the vagina and cervix is ​​a woman allowed to undergo surgery. Another contraindication is invasive cancer. As the disease progresses, intervention can cause life-threatening consequences.

The operation is not performed on HIV-infected patients, as well as on people who have problems with blood clotting.

Types of intervention

Some time ago, conization was carried out only with a scalpel. Currently, electric current, radio knife, laser, and liquid nitrogen are used to remove the pathological area. The listed methods are considered less traumatic and shorten the rehabilitation period.

Based on the volume of the area to be removed, the following types are distinguished:

• gentle conization - in this case, 1–1.5 cm of tissue and a small section (up to 20% of the length) of the cervical canal are removed;
• deep conization - represents the excision of 5–7 cm of tissue, including some fragments of healthy endometrium, and more than 65% of the length of the cervical canal.

Knife conization

This method is currently not used or is used in extreme cases when other means for performing the operation are unavailable. This method is based on the use of a scalpel. In this case, pathological areas are excised and sent for biopsy. After this, stitches are applied. The operation is performed under local conduction anesthesia or general anesthesia. There are no advantages to this method of intervention, but there are a lot of disadvantages, the main ones of which are:

• high risk of bleeding;
• long period of rehabilitation;
• inability to conceive a child;
• cicatricial changes in the cervix;
• deformation of the cervical canal.

This type of surgery increases the risk of recurrence of dysplasia. When a pathological area is removed, a significant part of the healthy endometrium suffers, which is a favorable prerequisite for the formation of a large amount of connective tissue.

Laser conization

Performing surgery using a laser allows you to avoid affecting large areas of healthy tissue. This method is less traumatic and therefore allows for a quick recovery. During conization using this method, pathological tissues are exposed to high temperatures, as a result of which the liquid evaporates from them. A thin crust forms on the surface of the cervix, which gradually peels off. This method is often recommended for nulliparous and young women for whom it is important to maintain the ability to conceive.

Advantages of laser conization:

• rapid tissue healing;
• low likelihood of bleeding;
• The elasticity of the cervix is ​​maintained.

• the possibility of burning healthy tissue;
• skipping a pathological area that provokes a relapse.

During laser removal there is no risk of tissue infection (as when performing surgery using a scalpel).

Cryoconization

Cryoconization is most often carried out using liquid nitrogen applications. Carbon dioxide or freon is used less often. This method is the opposite in action to the previous one. During cryoconization, pathological tissues are frozen and die under the influence of low temperatures. The procedure does not take more than 5–10 minutes and is indicated for young nulliparous girls with stage 1–2 dysplasia. This method is considered the most gentle of those presented.

Main advantages:

• absence of cicatricial deformities of the cervix;
• fast rehabilitation;
• reducing the risk of bleeding;
• there is no need to use general anesthesia.

The disadvantage of this method is the high probability of relapse, in which repeated intervention is indicated.

During cryoconization, local conduction anesthesia is used. When nitrogen comes into contact with tissues, there may be a feeling of slight nagging pain in the lower abdomen.

Radio wave method

This method is the most expensive, but also effective at present. The device emits high-frequency waves that are able to excise pathological tissue gently and accurately. For these purposes, a special tip is used that does not come into contact with the intended surgical field. The American-made Surgitron device is often used to remove areas of dysplasia. It is equipped with a small loop that carefully excises the affected tissue without injuring healthy tissue. The frequency and intensity of the radiation can be adjusted based on the depth of the upcoming exposure.

The radio wave method is suitable for eliminating stages 1–2 of dysplasia, as well as for those who want to maintain full reproductive function. Advantages of this method:

• absence of seams and scars;
• the ability to preserve healthy tissue;
• precision of manipulation, low risk of injury to normal epithelium.

The disadvantage of this method is its high cost.

The operation using a radio wave apparatus does not take more than 15 minutes. In addition, the tip does not touch the epithelium, but is located above it. A specialist monitors the entire process using a colposcope.

What is radio wave conization - video

Electroconization

This method involves the use of electric current. In this case, the affected area coagulates in the shape of a cone. Up to 3 cm of healthy tissue is affected, which is necessary to reduce the likelihood of relapse of the disease. During electrocoagulation, the tissues are charred, a scab is formed, which disappears within a week. To remove some portion of the cervix, a tip with a small loop at the end is used. This method of treating dysplasia is very common in public clinics and is often used in advanced forms of the disease.

Advantages:

• complete elimination of altered tissues;
• no relapse.

Disadvantages of the method:

• impossibility of use for advanced cervical varicose veins, as the risk of bleeding increases;
• the chances of conception decrease;
• the elasticity of the cervix deteriorates;
• there is a high risk of scar tissue changes.

I know firsthand what electroconization is. After a biopsy, endometrial hyperplasia was revealed. The gynecologist recommended conization. In addition, there was great erosion. I had to agree to the operation. I asked the doctor for general anesthesia because it was scary. After the intervention, there was pain in the lower abdomen and a burning sensation. I recovered from anesthesia for almost a day. The temperature has risen. After conization, a scar appeared on the uterus, and subsequently an endometrioid cyst. I got upset and went to another gynecologist, who said that electroconization is used in extreme cases and everything could have been done much more carefully and without consequences with a laser. I regret that I agreed then. Then the scar and endometriosis were removed with a laser. I recommend that you familiarize yourself with all known methods, as well as listen to the opinions of several doctors before resorting to such a traumatic method.

Preparing for surgery

Before the operation you must:

1. Take a smear for flora and common infections: chlamydia, trichomoniasis, etc.
2. Take a general blood test to rule out inflammation, serious illnesses and poor clotting ability.
3. Have a colposcopy. Examination of the cervix under a microscope is an important point before intervention, as it allows us to identify additional changes in the endometrium.
4. Perform fluorography and cardiogram. In case of tuberculosis and severe heart diseases, conization is not performed.
5. Donate blood for syphilis.
6. Undergo an ultrasound examination of the pelvic organs.
7. Abstain from sexual intercourse for 1 day.

Conization is carried out only on the 1st–2nd day after the end of menstruation. This is due to the active production of estrogens, which allows tissues to regenerate faster after the intervention.

On the day of surgery, you need to wash your face; you should not douche. It is necessary to take everything you need with you, since immediately after the intervention you will have to spend several hours in the hospital. If conization is performed under general anesthesia, it is also not recommended to eat or drink on the day of the operation.

How the intervention is carried out

The tactics of conization depend on the type of intervention, but the algorithm of actions is similar for all manipulations. Main stages:

1. The specialist asks the woman to sit comfortably on the gynecological chair.
2. Then a special speculum is inserted into the vagina, allowing access to the cervix.
3. Then the anesthetic is injected into the uterus. The injection may cause minor discomfort.
4. After 5–7 minutes, the doctor begins to remove the pathological area. If the use of liquid nitrogen is intended, then the specialist inserts a thin and long probe into the vaginal cavity, then cold is applied. With the laser method, all altered areas are sequentially evaporated using a special tip that delivers a beam of a certain length. If electrocoagulation is used, the affected tissue fragment undergoes “charring”, which occurs when exposed to electric current. When using a radio wave knife, the area of ​​dysplasia is carefully cut off. If a scalpel is used, the doctor first marks the incision lines and only then excises the marked area. The microscope helps control the manipulation.
5. After removing the pathological area, the intervention site is treated with an antiseptic. The woman is transferred to the ward.
6. After 3–6 hours the patient is allowed to go home.

Immediately before gross interventions, such as electrocoagulation and knife conization, an injection is administered that accelerates blood clotting.

Postoperative period

Immediately after the operation, you may feel pain in the lower abdomen, but there is nothing to worry about. Usually, unpleasant symptoms disappear on the second day. In the first few weeks, spotting brown discharge may be present. This is not a sign of pathology. Complete tissue healing occurs within 1–1.5 months. The scab formed after conization often comes off within 7–10 days. It resembles a brown dense clot. You shouldn’t be afraid of its appearance, but after it leaves, the discharge may increase.

During the postoperative period, the following rules must be observed:

1. Change gaskets regularly.
2. Do not douche under any circumstances, but be sure to wash the external genitalia 2 times a day. During the recovery period, the doctor may recommend Miramistin or a weak solution of potassium permanganate for these purposes. This is necessary in order not to provoke infection of the wound.
3. Abstain from sex for at least 1.5 months. You can resume sexual activity only with the doctor’s permission after the postoperative wound has completely healed.
4. Do not lift heavy objects.
5. Do not take a bath for a month, but use a warm shower (not hot).
6. Do not visit baths, saunas or sunbathe.
7. Refrain from playing sports.

If, after the scab has passed, heavy bleeding occurs that does not stop, you should immediately consult a doctor.

In some cases, broad-spectrum antibiotics are prescribed during the recovery period. This measure is necessary if there is a high risk of postoperative complications. To eliminate pain, analgesics are used: Solpadeine, Tempalgin, etc.

If the pain intensifies and does not go away within 2-3 days, then it is important to contact a gynecologist who can identify possible complications in the initial stages. 2–3 weeks after the intervention, you must visit a doctor to monitor the condition of the postoperative wound.

Complications after the intervention

If the operation was performed by an experienced specialist, then the risk of serious complications is low, especially when using the latest techniques. However, in some cases, undesirable consequences may occur, such as:

• the appearance of a scar on the cervix;
• recurrence of dysplasia;
• the occurrence of endometriosis;
• narrowing of the cervical canal;
• bleeding.

Conization can affect reproductive function. If the operation is performed correctly, the ability to conceive is preserved, however, due to the fact that at the site of removal of the endometrium the organ loses its elasticity, massive ruptures are possible during childbirth, which will provoke bleeding. The risk of premature dilation of the cervix also increases; pregnancy may be terminated due to weakness of the muscular system of the organ at the site of intervention.

If you have ever had conization of the cervix, then before planning a pregnancy it is important to inform your doctor about this, who will prescribe the necessary tests and perform a colposcopy.

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.

1. An area of ​​mucous membrane with pathological changes within the unchanged tissue is removed (healthy tissue within 5-7 mm is captured).
2. The removed section of the cervix is ​​sent for pathohistological examination.
3. If the study excludes invasive cancer, and the edges of the removed cone do not contain dysplastic changes, the pathology is considered radically cured.
4. 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:

1. In the presence of an inflammatory process in the vagina and cervix.
2. For biopsy-proven invasive cancer.
3. For acute infectious diseases.
4. When the boundaries of epithelial transformation are poorly defined.
5. If the boundaries of pathology go beyond the technical capabilities of treatment.
6. For decompensation of chronic diseases (heart failure, hypertension, diabetes, renal and liver failure).
7. 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:

1. Economical conization (cone-shaped biopsy) - the size of the removed area is no more than 1-1.5 cm.
2. 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:

1. There is a risk of burns to surrounding healthy tissue.
2. In most cases, general anesthesia is required for maximum immobilization (the patient should not move).
3. 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:

1. Heavy bleeding, like menstruation
2. Increased body temperature.
3. Continued discharge for more than 4 weeks or no decrease in discharge volume by the 3rd week.
4. Burning and itching in the vagina.
5. The appearance of pain in the lower abdomen some time after the operation (pain for several days immediately after conization is normal).
6. 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.

Review - Anna

I have a very pleasant impression from the clinic itself and from the clinic staff. Many thanks to the manager. Anistratenko Sergei Ivanovich, who performed the operation on me to remove fibroids, for his professional advice and the successfully performed operation. This man has “golden hands”, I would like to wish him good health, happiness and all the best. In general, we can only say good things about this clinic: the service, quality and conditions are at the highest level, despite the fact that the clinic is young. The staff is polite, the food is very tasty, the clinic itself is clean and tidy. Many thanks to all employees! I only wish further professional growth and development for the employees and the clinic to remain at the same level!

Review - Elena

When entering the Clinic, I felt only fear. Having met the doctors and nurses, I calmed down and realized that everyone wanted to do the best for me. In a word. It was like being at a resort, the attitude was excellent; if God forbid... I will only contact the “Good Prognosis” clinic. I’m happy with everything. I don’t know how to speak, I write as I feel. Health to everyone!!!

Review - Elena

I am very grateful for the attention of the nurses and nursing staff to the patients, the food was very tasty and high quality, the whole team was very friendly, I am immensely grateful to everyone. Thank you! I wish you good health, good health and prosperity to you all.

Review - Tamara

I am Tamara Yosifovna, a resident of Zaporozhye, who underwent surgery to correct urinary incontinence at the Good Forecast clinic. And I express my deep gratitude to the entire team that works in this clinic - for extensive consultation, for excellent moral support, for a comprehensive and in-depth examination of all doctors, and especially the ultrasound doctor Vladimir Ivanovich Ryzhov... For the trouble-free, competent and impeccable provision of medical care... All employees , the “Good Forecast” clinics are very attentive, scrupulous, friendly, and also responsible to all patients who come to them with their problems... I would especially like to note the high professionalism and competent approach to my work of my leading surgeon Sergei Ivanovich Anistratenko; as well as Volkov Vladislav Vladimirovich - an irreplaceable anesthesiologist and psychologist - in the second person and resuscitation nurse Victoria Maletskaya. Thank you very much for your golden hands, bright head, kind angelic heart and integral professional work. I bow to you for being in the world and immaculately helping others. All conditions at the clinic are excellent. The food is excellent - there is no comparison with any wide-profile restaurant, the food at the clinic is homemade - very tasty, refined and varied... And the comfort and cleanliness are like in EDEM... Thanks to all the nurses - for your kindness, attention, scrupulousness and responsibility - a deep bow to you... And so Many thanks to the technical staff - for the ideal cleanliness, home comfort, order, maternal attention and warmth of soul. I would also like to thank all the girls working at the reception, the administrator Roskina Alena and Berezanets Marinka - for the quick, deeply detailed consultation, for the respect and kindness towards visitors. I would also like to note and thank the guards: Alexandra Evstafiev and Alexandra Slobodyanyk - for their vigilance, hard work, respect for everyone and professionalism. Thank you to the management, administration and all the organizers who created this bright corner of paradise called: the “Good Forecast” clinic. My wish is that your professionalism meets no obstacles, that your love for your very necessary profession and great patience for the sick never fades away. And we, who turned to you, always left healthy, happy and with warmth in our souls. I wish you further prosperity, all-round love and respect. Peace and goodness to everyone and unlimited professional development.

Review - Anna

The clinic has the highest level of care, which meets European standards. Create a series of clinics throughout Ukraine.

Review - Tatiana

High level clinic: Amazing staff. Wonderful doctors! Tasty food. Cleanliness of rooms and bed linen.

Review - Inna

Thank you very much for the attentive, sensitive attitude of the medical staff. I had no idea that there were still clinics with such an attitude. The atmosphere is welcoming and open. Of course, I will recommend your clinic to all my friends and relatives. Special thanks to the excellent doctor, a professional in her field, Anna Alexandrovna Averina. Health to you, A.A., good luck and success! Prosperity to your clinic.

Review - Galina

The enemies themselves are kind, they are the most positive. Irina Volodymyrivna is a doctor like God, please encourage me first, explain correctly. I'm glad that I took my problem to this clinic myself. Health to everyone who works in this clinic. As of now, you are already the best! Don't ruin what you deserve!

Review - Oksana

Our deepest hearts go out to the doctor and to all the staff at the clinic. All services were given at the highest level. I wish everyone good health and well. Be patient, don’t give up no matter the difficulties.

Review - Inna

With all my heart I want to express my deep gratitude to all the staff of the Good Forecast clinic. I especially want to say thanks to my attending physician Valery Aleksandrovich Zabolotin, who performed a very complex operation, while saving my uterus, family, and future. I would like to thank the anesthesiologist Yulia Grigorievna, I felt great after general anesthesia, thanks to the nurses who monitored my condition (thanks to nurse Vika, who found an individual approach to each patient. Professionalism, trust in the doctor, understanding, positivity, quality treatment are very important to me I received all this at the “Good Forecast” clinic. I would like to give birth to you in the future

Conization of the cervix is ​​an operation in which a cone-shaped excision of the affected tissue is performed. The procedure is performed for therapeutic and diagnostic purposes for various diseases, when other methods have proven ineffective or cannot be used for any reason. Until recently, conization was carried out with a regular scalpel. In modern gynecology, radio waves and other techniques are actively used to obtain quick and guaranteed results.

Radio wave conization of the cervix is ​​the excision of an area of ​​the desired size using electromagnetic waves. The goal of such treatment is to eliminate the pathological focus (erosion) and save the woman from the possible consequences of this pathology. Radioconization is recognized as one of the most effective and safe methods of therapy and is considered the best option for young nulliparous women.

Advantages of radio wave conization of the cervix

Compared to the classical technique, manipulation has a number of advantages:

• Low invasiveness: radio waves are directed specifically at the pathological focus, healthy tissues are not affected;
• Possibility of use in nulliparous women: after the procedure, the structure of the cervix is ​​not disturbed, no scars remain;
• Low risk of complications;
• Minimal risk of bleeding: the wound surface is treated directly during the procedure, the vessels are coagulated;
• Radical removal of affected tissue in one stage;
• Possibility of obtaining tissues for histological examination;
• Painless;
• Short rehabilitation period (4 weeks);
• Possibility of carrying out on an outpatient basis.

All these factors make radioconization the method of choice for the treatment of cervical pathology in women planning pregnancy.

Radioconization involves the removal of a pathological cone-shaped area of ​​the cervix with the capture of healthy tissue.

On a note

As an alternative, the doctor may suggest laser conization - an effective, comfortable and safe treatment method.

Indications for surgery

Conization refers to surgical methods for treating diseases of the cervix. In clinical practice, various techniques for cone-shaped tissue excision can be used:

• Knife – traditional excision of tissue with a scalpel;
• Laser conization;
• Radio wave conization.

On a note

Reviews from patients clearly indicate that radio wave and laser conization are much better tolerated and usually proceed without complications.

Indications for conization:

• Cervical dysplasia stages II and III (CIN);
• Recurrent grade I dysplasia, not amenable to treatment by other methods;
• Erosion of the cervix with pronounced cicatricial deformities;
• Inability to visualize the transformation zone during colposcopy;
• Spread of the pathological process into the cervical canal;
• Cancer in situ (stage 0, non-invasive cancer, that is, not extending beyond the epithelium) - in some cases.

One of the indications for cone-shaped tissue excision is the development of cervical dysplasia, which can eventually develop into a malignant formation.

The possibility of using one or another conization method depends on the technical equipment of the clinic and the qualifications of the doctor. Modern medical centers are trying to offer their patients conization of the cervix using the radio wave method. This is one of the most effective and safest methods of surgical treatment, allowing you to radically solve the problem without consequences for reproductive health.

On a note

The question of using one or another method of influence is always decided individually based on the severity of the patient’s condition and the presence of concomitant pathology.

For complicated erosion, ectropion, leukoplakia and other diseases, conservative methods are usually first used (cauterization of the cervix with radio waves, etc.). Lack of effect is a reason to prescribe radio wave conization of the cervix.

Contraindications to surgical treatment

Radio wave conization is not performed in the following conditions:

• Inflammatory process on the cervix;
• Invasive cancer;
• Pregnancy (the operation is performed after the birth of the child and completion of the lactation period).

During pregnancy, radio wave conization is contraindicated.

Quite often, diseases of the cervix (dysplasia, ectropion) are combined with cervicitis - inflammation of the cervical canal. In addition to contact bleeding, profuse vaginal discharge with an unpleasant odor appears, and there is itching and burning in the vagina. Cervicitis not only aggravates the course of the disease, but also contributes to the development of complications. If conization is carried out against the background of active inflammation, the infection can spread to the overlying organs - the uterus and appendages. The operation is prescribed only after complete cure of cervicitis.

For invasive cancer that has penetrated beyond the mucous layer, radioconization is not effective. In this situation, the only treatment may be to remove the uterus (hysterectomy).

Preparation for radio wave treatment

Before the procedure, a woman must undergo a full examination:

• Smear for oncocytology;
• Colposcopy;
• Biopsy (if indicated);
• Examination for STIs, including human papillomavirus (if a concomitant infection is suspected).

After the examination, the doctor makes a final diagnosis and determines treatment tactics. If a decision is made to perform radiosurgical conization of the cervix, the following tests are prescribed:

• Survey smear on the flora;
• Bacteriological culture from the cervical canal.

Using a survey smear, the state of the microflora of the woman’s genitourinary system is assessed and the presence of pathogenic microorganisms is detected.

These examinations can also be carried out at the stage of primary diagnosis to find the cause of erosion. Further additional tests are prescribed:

• Blood chemistry;
• General blood and urine tests;
• Coagulogram;
• Tests for infections (HIV, hepatitis, syphilis);
• Determination of blood group and Rh factor;
• ECG and consultation with a therapist.

Scheme of radioconization and the essence of the procedure

In most cases, the operation is performed under local anesthesia. For pain relief, an anesthetic injection is given into the cervix: 0.1% lidocaine along with adrenaline (to reduce bleeding). In special situations, the procedure can be performed under short-term anesthesia.

Radiosurgical conization of the cervix is ​​prescribed in the first middle of the cycle. It is optimal to perform the operation on days 5-7. If a woman's menstruation lasts about 6-7 days, the procedure is postponed to another time. There should be no menstrual flow on the day of surgery.

On a note

For postmenopausal women, conization is performed at any time.

Progress of the operation:

1. The patient is positioned on a gynecological chair;
2. The cervix is ​​exposed in the speculum, the instrument is fixed;
3. Vaginal discharge is removed with a cotton swab;
4. Colposcopy is performed: pathologically altered areas of the cervix are recorded, the conization zone is determined;
5. Local anesthesia is performed;
6. The electrodes are connected, the radio knife is prepared;
7. The pathological area is excised in a cone shape with a radio wave knife. During the operation, the doctor captures the changed tissue on the cervix and 1/3 or 2/3 of the cervical canal;
8. The removed tissue is grabbed with tweezers;
9. The resulting material is sent to the laboratory for histological examination;
10. Bleeding areas coagulate.

During radiosurgical conization, an electrode-sail is connected, and then the pathological area is excised with a radioknife.

The whole procedure takes about 15-20 minutes. After radiosurgical conization, sutures are not placed on the cervix, since bleeding is stopped directly during the procedure. This reduces the recovery period and significantly reduces the risk of postoperative complications.

On a note

Reviews of radioconization indicate that most patients tolerate this procedure well. It is not painful, and all the patient experiences during the operation is some discomfort in the lower abdomen (provided there is adequate anesthesia). The cervix heals faster than with other treatment regimens, and after 4 weeks the woman can return to her usual lifestyle. In the first two weeks after the operation, there may be minor bloody discharge that does not cause significant discomfort. Complications after radiosurgical conization are quite rare.

To carry out radio wave treatment, a modern Surgitron device is used. With its help, not only conization is carried out, but also radio wave loop excision - capturing a small area of ​​the cervix with a thin wire loop.

On a note

There is a slight difference between the concepts of conization and excision. Usually we talk about excision (or cone excision) when it is necessary to remove a small section of the cervix along with the lower part of the cervical canal. In foreign literature, this procedure is called LEEP. The term "conization" is correct when half or 2/3 of the cervical canal is removed, and a radioknife is used for this procedure. The technique is similar, the only difference is in the tools used.

Photos of the cervix before and after radioconization can be seen below.

Recovery after the radioconization procedure lasts from 4 to 8 weeks.

Advantages of using the Surgitron device:

• Low risk of developing inflammation and burns of the wound surface (tissue temperature at the incision site does not exceed 55 °C);
• All manipulations are carried out gently, effortlessly, which eliminates compression and displacement of tissues;
• Possibility of simultaneous tissue dissection and bleeding stop;
• The operation is performed in a “dry wound” without bleeding, which improves visualization of the pathological focus;
• Non-contact – low risk of infection;
• Possibility of targeted impact on the pathological focus - healthy tissues are not damaged;
• The procedure can be performed in close proximity to blood vessels and nerves.

As an alternative to Surgitron, the Fotek device can be used.

Radiosurgical conization of the cervix is ​​performed, among other things, using the domestically produced device “Fotek”.

The cost of radiosurgical conization depends on the region and the status of the clinic. In Moscow, the price of the operation is 25-40 thousand rubles; in the regions the cost may be lower. If a radio wave machine is installed in the antenatal clinic, the procedure can be done free of charge under the compulsory medical insurance policy.

For a speedy recovery, a woman should follow some rules during the first month after the procedure:

• Sexual activity is prohibited until the mucous membrane of the cervix is ​​completely restored (an average of 4 weeks);
• It is not recommended to lift weights (more than 5 kg), engage in active sports, or physically overexert;
• It is forbidden to visit the swimming pool, bathhouse, sauna, or lie in a hot bath;
• You cannot use tampons or douche;
• You should not take any medications without a doctor's prescription.

On average, healing of the cervix occurs in 4-5 weeks. The cervix takes a long time to heal if a woman does not follow the doctor’s recommendations and violates the prescribed prohibitions.

Postoperative period: norm and pathology

In the first days after radio wave conization of the cervix, there is sanguineous discharge from the genital tract. Gradually, the volume of discharge decreases, and by the third week it completely disappears. A specific odor may appear from the discharge - not too strong, but unpleasant. By the end of the first month after surgery, all discharge should completely stop.

Nagging pain in the lower abdomen may occur directly during the procedure, as well as during the first week after surgery. The pain is mild, localized above the pubis in the center, and is not accompanied by a significant deterioration of the condition. If you don’t want to endure pain, you can take No-shpa or Nurofen (no more than 3 days in a row).

Radioconization of the cervix does not have a significant effect on the menstrual cycle, and most women have their periods on time. There may be a slight delay of up to 3-5 days. According to reviews, the first periods may be heavy and painful, but later the cycle is completely restored.

As a rule, the menstrual cycle after the radioconization procedure of the cervix resumes on time.

The general condition after surgery is usually satisfactory. Some women note an increase in body temperature to 37-37.5 °C. The temperature lasts no more than three days; antipyretics are not prescribed.

Moderate nagging pain in the lower abdomen, sanguineous vaginal discharge and a slight delay in menstruation are normal after conization.

Warning symptoms to look out for:

• Continuous or increasing bleeding from the genital tract (profuse, with clots);
• Severe pain in the lower abdomen;
• Increased body temperature more than 37.5 °C;
• The appearance of purulent discharge;
• Copious discharge with an unpleasant odor 3 weeks after surgery;
• Delay of menstruation for more than 7 days.

All these symptoms indicate the possible development of complications and require mandatory consultation with a doctor.

A follow-up examination by a doctor after conization is carried out after 2 weeks, colposcopy - after 4-6 months. If the examination results are good, the woman should visit the doctor every 6 months or more often if indicated.

Undesirable consequences and complications

Conization of the cervix using the radio wave method can lead to the development of the following complications:

• Bleeding is an extremely rare complication, since the vessels coagulate immediately after the incision (1-2% of cases);
• Wound infection – occurs when personal hygiene rules are not observed or in the presence of chronic cervicitis at the time of surgery (1-2%).

Following the rules of personal hygiene will help to avoid various infectious complications after surgery.

If for some reason conization was carried out repeatedly, the risk of the following complications increases:

• Scarring of the cervix;
• Cervical canal stenosis.

The use of modern techniques makes it possible to reduce the likelihood of such consequences to almost zero.

Pregnancy and childbirth after radioconization

Unlike other treatment methods, after radioconization, stenosis of the cervical canal does not occur and complications that can affect the course of pregnancy and childbirth do not develop. The cervix heals without scarring. The cervical canal remains patent and sperm can fertilize the egg without interference. After the therapy, a woman can conceive a child. It is recommended to plan pregnancy 2-3 months after surgery.

It is important to know

Properly performed radioconization does not interfere with conception, pregnancy, or natural childbirth.

Radioconization of the cervix does not affect the course of pregnancy and does not interfere with the development of the fetus. Since scars do not form on the cervix, the woman is not at risk of developing isthmic-cervical insufficiency. In the absence of other complications, a successful pregnancy and birth of a child is possible.

Childbirth after surgical treatment occurs without complications. A woman can safely give birth to a child through the vaginal birth canal. Radio wave treatment is a gentle method that does not have a negative effect on the cervix, does not interfere with its stretching during childbirth and does not interfere with the birth of the baby.

The successful course of pregnancy and childbirth largely depends on how the postoperative period went. If a woman followed all the doctor’s recommendations and was regularly observed by a gynecologist, she has a very high chance of experiencing all the joy of motherhood without significant problems and complications.

Interesting video about the benefits of radio wave conization

Schematic: technique for performing conization of the cervix