Cervical Excision Procedures: Loop Electrosurgical Excision Procedure and Cold Knife Cone


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  • Excision is widely used as treatment for high-grade squamous intraepithelial lesions (HSIL) of the uterine cervix (cervical intraepithelial neoplasia [CIN2 and CIN3]).* It is preferred over ablation:
    • With large lesions (> 75% of cervix area)
    • With large lesions (> 75% of cervix area)
    • With lesions extending into the endocervical canal
  • If the transformation zone is not fully visualized
  • LEEP is usually an office procedure performed under local anesthesia.
  • CKC is performed in the operating room usually with general or regional anesthesia.
  • Excision provides tissue for histologic examination. It:
    • Reduces risk of missing occult invasive cancer
    • Allows assessment of surgical margins
    • Success rates high with both LEEP and CKC
    • Risk of recurrence lower with CKC
    • Perinatal risks in subsequent pregnancy is higher with CKC

*LAST terminology is used in this module


  • Alan G. Waxman, MD, MPH, Department of Obstetrics & Gynecology, University of New Mexico


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  • Teoh D, Musa F, Salani R, Huh W, Jimenez E. Diagnosis and Management of Adenocarcinoma in Situ: A Society of Gynecologic Oncology Evidence-Based Review and Recommendations. Obstet Gynecol. 2020;135(4):869-878.

Developed in association with ASCCP, the society for lower genital tract disorders.