LASER MINICONIZATION PROCEDURE

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