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Operations: Cone biopsy of cervix uteri (including laser)

Insurance code: Q0330

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation: Cone biopsy is one of the ways of treating pre-cancerous changes on the cervix and allows tissue to be removed for pathological examination. Similar techniques such as diathermy loop excision are now used more frequently since they have a lower long term complication rate.

Description of procedure: A ‘cone’ shaped piece of tissue is removed by surgical excision with a knife or directed laser beam and sent for histology. The base of the cone is either secured with stitches or cauterised with a de-focussed laser beam to secure blood vessels

Anaesthetic: Local anaesthetic is often used for laser cone biopsy and general anaesthetic for knife biopsy

Length of stay: Out-patient for laser cone and day case for knife cone biopsy

Post-operative management: A watery blood stained discharge is normal and expected for one month following the treatment. If there is a heavy, smelly or very bloody discharge this is normally the signs of infection and a short course of antibiotics are required. Sex, soaking in the bath and prolonged tampon use are best avoided for one month to reduce the risk of infection.

Potential complications: Bleeding at the time of treatment is unusual. The commonest complication is bleeding which occurs 10 – 14 days after treatment. These bleeds are usually due to infection and require a course of antibiotics. Rarely the bleeding can be quite heavy and require a stitch through the cervix to stop the bleeding. This usually requires a general anaesthetic and happens in fewer than 1% of cases.

Post-operative consultation: A repeat colposcopy and smear test are normally organised for 6 months after treatment although this is reduced to 4 months if someone is hoping to get pregnant. Colposcopy follow up is not required if there is no pre-cancerous skin present in the treatment biopsy.

Relevant websites:

1. http://www.bsccp.org.uk/index.asp?PageID=29

2. http://www.cancerhelp.org.uk/help/default.asp?page=2760#cone