Atlas of Colposcopy: Principles and Practice

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Treatment by LLETZ – Instruments and consumables  

  • Examination table
  • Examination gloves
  • Insulated self-retaining speculum with a smoke extraction channel
  • Lateral vaginal speculum (rarely necessary)
  • Sponge-holding forceps
  • Cotton-tipped swabs
  • Freshly prepared 5% acetic acid
  • Lugol’s iodine
  • Focusing light for examination
  • Suction machine
  • Colposcope
  • Electrosurgical unit (ESU)
  • Loop/ball electrodes
  • Hand-operated switch for the ESU
  • Monsel’s solution/paste
  • Local anaesthetic (lignocaine or prilocaine) injection
  • Adrenaline
  • Dental syringe (preferred) or 10 cc syringe and needles
  • Vials containing 10% formaldehyde for collecting tissue for biopsy
  • Gauze pieces
  • Sutures to control bleeding

Preparation of dental syringe and needle

  • The smoke generated must be sucked out either by a smoke evacuator (preferred) or by a suction machine attached to the smoke extraction channel.
  • An insulated speculum is preferred but not essential. Regularly check the insulated speculum for any damage to the insulation coating.
  • An insulated lateral vaginal retractor may be used if the lateral vaginal walls are patulous and obstruct the view. However, it causes discomfort to the patient. A non-lubricated condom (with its end cut off) stretched around the speculum can also hold back the vaginal walls away.
  • In most cases the procedure can be performed under local anaesthesia. Regional or general anaesthesia is required if:
    • the lesion is large and/or extends to the vagina
    • exposure is difficult
    • the woman is uncooperative
    • An electrosurgical generator requires that a patient-return electrode or dispersive plate is used to allow the electrical circuit to be completed and the optimal current to flow. The patient-return plate should be placed under buttocks of the patient.

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