CONE BIOPSY AND LEEP
If the endocervical curettage findings indicate abnormal changes or if the lesion extends into the canal, the patient may undergo a cone biopsy. This can be performed surgically or with a procedure called LEEP (loop electrosurgical excision procedure), which uses a laser beam.
Usually performed in the outpatient setting, LEEP is associ-ated with a high success rate in removal of abnormal cervical tis-sue and has a low incidence of complications (ACOG Committee Opinion #195, 1998). The gynecologist excises a small amount of cervical tissue, and the pathologist examines the borders of the specimen to determine if they are free of disease. A patient anesthetized for a surgical cone biopsy is advised to rest for 24 hours after the procedure and to leave any vaginal packing in place until the physician removes it (usually the next day). The patient is in-structed to report any excessive bleeding.
Guidelines regarding postoperative sexual activity, bathing, and other activities are provided by the nurse or the physician. Be-cause open tissue may be potentially exposed to HIV and other pathogens, the patient is usually cautioned to avoid intercourse until healing is complete and verified at follow-up. Cervical steno-sis can be a complication of this procedure.