Cervix–Cervical Intraepithelial Neoplasia
Although treatment of cervical intraepithelial neoplasia (CIN) is now more commonly performed by the large-loop excisional technique, the laser was the ideal method of treatment of the 1980s and still offers another option. Treatment of CIN can be performed by vaporization or by excisional conization using the laser as a substitute for the scalpel. The major advantages of the laser for the treatment of CIN include:
- High degree of clinical efficacy
- Bloodless field
- Microscopic precision
- Sparing of normal tissue
- Rapid healing with minimal scar formation
- Small number of complications
- Outpatient methodology
VAPORIZATION
When using the laser coupled to the colposcope, one should first define the extent of the lesion. One should keep in mind that endocervical glands may lie deep in the stroma to a depth of 6–7 mm; therefore, treatment should be carried out to a minimum of 9–10 mm with a peripheral margin of 3 mm. This procedure is performed with 30–40 W of power with a 2-mm-diameter spot and takes about 5–10 minutes to complete under local anesthesia. Vaporization is performed to a minimal depth of 1 cm and ends at the level of the endocervical canal. The cervical defect should resemble a funnel, as if one performed a small cone biopsy.
The operative site is circumferentially outlined with a 3- to 5-mm margin around the lesion. The cervix is then divided into four quadrants. Power is increased to 30–40 W. Beginning in the lower quadrants and using a circular pattern, vaporization is carried down to a depth of 1 cm. The endocervical canal is usually spared. Measurements are made at frequent intervals, relating the depth to the surrounding ectocervical surface. When the lower half of the cervix has been vaporized, a similar procedure is followed for the anterior surface.
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