The Common Vein Copyright 2010
Definition
Loop Electrosurgical Excision Procedure (LEEP) is a gynecologic procedure used the treatment of cervical intraepithelial neoplasia (CIN), a precursor to cervical cancer. The procedure uses a cauterizing wire loop to remove a cone-shaped section of cervix.
Indications
LEEP is indicated for CIN lesions limited to the ectocervix. Larger lesions or lesions involving the endocervix are usually treated with conization procedures using either a scalpel or laser.
Contraindications
Contraindications to LEEP are limited as it is a procedure that can be performed safely in an office environment under local anesthesia. However, LEEP in contraindicated in women who are pregnant or with active cervicitis. Women for whom LEEP is relatively contraindicated include women who are less than 3 months post-partum, young women with small cervices and post-menopausal women with severe cervical atrophy.
Advantages
LEEP is a safe procedure that can be performed in an office environment under only local anesthesia. The electrical current is not sufficient to cause major thermal damage to the cervical tissue. The current is sufficient to provide good hemostasis and cause lysis of residual tumor cells in the biopsy margin.
Disadvantages
Complications of LEEP may include cervical stenosis, cervical insufficiency and bleeding. Scarring of the cervical os after the procedure can lead to cervical stenosis. This can be significant and result in infertility. Thinning of the cervix from the procedure may also result in cervical insufficiency during a subsequent pregnancy. The electrical current usually produces hemostasis. However, with any procedure, bleeding may occur. Complications of LEEP are rare.
Aim
The aim of LEEP is both diagnostic and therapeutic. LEEP is performed on women with CIN seen on biopsy during colposcopy. LEEP is performed to remove the lesion form the ectocervix. Pathologic examination of the specimen after LEEP makes the definitive diagnosis of CIN by ruling out the existence of concurrent cervical cancer. At the same time, removal of the CIN lesion with clean margins is also therapeutic, preventing the lesion’s progression to cervical cancer.
Patient Preparation
LEEP is done in the gynecologist’s office under local anesthesia. If there is a possibility the patient may be pregnant, a pregnancy test should be administered prior to the procedure. Cervical swelling in the days after the procedure may cause retention of menstrual blood, so the procedure should be scheduled according to the woman’s menstrual cycle and timed after the cessation of menstrual flow. The patient is positioned on the examination table with her legs supported. A speculum and retractors are used to
expose the cervix. An acetic acid solution is used to highlight the abnormal epithelium. Local anesthesia is injected around the procedure site to prevent pain.
Equipment
An electrified wire loop is used to perform the LEEP procedure. A colposcope is used to guide the procedure. A speculum and retractor are used to expose the cervix.
Technique
The electrified loop is used to remove a cone shaped piece of tissue encompassing the cervical os. The piece of tissue should include the border of the abnormal epithelium with a margin of normal tissue. The electrical current can be adjusted with easily cut the cervical tissue and provide adequate hemostasis. The removed tissue is placed in fixative and sent for pathologic examination.
Results
The result of the LEEP procedure is the removal of a cone-shaped wedge of cervical tissue. The removal of this tissue confirms the diagnosis of CIN by ruling out invasive foci of cervical carcinoma. The procedure is simultaneously the treatment for CIN, removal to prevent progression to cervical carcinoma.
Conclusion
LEEP is a common procedure for the treatment of cervical intraepithelial neoplasia using an electrified wire loop. Although rare complications do occur, the procedure is well tolerated by most patients, and has the advantage of requiring only local anesthesia.