What Does the Conization of Cervix Mean?

Conization is a procedure that removes a cone-shaped piece of tissue from the cervix.

The cervix is the mouth of the uterus that opens further into the vagina. Conization or cone biopsy of the cervix is a surgical procedure in which a small cone-shaped or cylindrical wedge of tissue is removed from the cervix (mouth of the uterus). It is regarded as an extensive form of cervical biopsy (a procedure in which a small piece of abnormal tissue is removed from the cervix and sent for lab examination). The removed tissue is sent for lab examination to check for signs of any disease. Conization may be done for the diagnosis of cancer of the cervix or to treat certain medical conditions involving the cervix. The wedge removed contains abnormal tissue along with a margin of healthy tissue. This suggests that most abnormal tissue is removed from the cervix.

The wedge of tissue may be removed using a scalpel (cold knife conization), a laser knife or a thin wire loop heated by an electric current (loop electrosurgical excision procedure or LEEP). Cold knife conization gives the cleanest biopsy margins for further lab study. It is, however, associated with more bleeding than laser or LEEP. Cold knife conization usually requires general anesthesia. Laser conization generally takes longer. It can even burn the margins of the specimen, which may interfere with the lab examination. LEEP procedures are better as they are rapid, preserve the margins for lab evaluation and cause minimal bleeding. A LEEP procedure can be performed in the doctor’s office or other outpatient settings.

• A conization procedure, especially LEEP conization, is usually done in the doctor’s office or other outpatient settings. The patient can generally go home on the same day.
• The doctor will explain the risks associated with the procedure to the patient. They will take their detailed medical history, do a physical examination and order tests as needed. 
• The patient will be asked to take off their clothes below the waist and cover themselves with a drape.
• The patient lies on their back on the examination table with their feet raised and supported by footrests or stirrups (lithotomy position).
• The doctor administers anesthesia (general, regional or local). IV painkillers may be given to reduce pain.
• The doctor will then insert a lubricated tool called a speculum into the patient’s vagina to gently spread the vaginal walls and examine the cervix.
• A wedge of tissue (cone biopsy) is collected from the cervix and sent for lab examination.
• After completing the procedure, the patient is observed in the recovery room before they are allowed to go home. They may need some help to go back home.

The risks associated with the conization procedure are

• Excessive bleeding
• Pain
• Cervical stenosis (abnormal narrowing of the cervix)
• Infertility (rare)
• Cervical incompetence (inability of the cervix to stay closed during pregnancy, which may lead to increased risk of abortions and preterm or premature delivery)
• Infections

Apart from the risks for the patient, laser conization may cause certain risks for the health provider as well. Laser conization and LEEP generate smoke, which may be dangerous for the operator to inhale. This is because the smoke may contain human papillomavirus (HPV) particles. The use of smoke evacuators is essential and wearing a mask during the procedure is recommended.