Atlas of Colposcopy: Principles and Practice

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Treatment by cold-knife conization – Steps  

  • Counsel the woman, and obtain informed consent.
  • The patient should have either regional (spinal or epidural) or general anaesthesia.
  • After appropriate antiseptic dressing and draping, introduce the posterior vaginal speculum to expose the cervix.
  • Apply Lugol’s iodine to the cervix to delineate the lesion.
  • Grasp the anterior lip of the cervix with a tenaculum beyond the ectocervical margin of the lesion.
  • Insert stitches lateral to the cervix (at the 3 o’clock and 9 o’clock positions) just below the cervicovaginal junction. Retraction of the lateral vaginal walls with a retractor by the assistant will facilitate this step.
  • Place a stitch at the 12 o’clock position close to the external os; this will help the pathologist to orient the specimen after surgery.

  • Inject 5–10 mL of premixed solution of 2% lignocaine and epinephrine at a concentration of 1:100 000 into the stroma of the ectocervix (just beneath the epithelium) at the periphery of the lesion, avoiding the 3 o’clock and 9 o’clock positions.

  • Make a circular incision starting at the 9 o’clock position on the face of the cervix beyond the limit of the lesion using a scalpel. Complete the incision on the posterior lip before moving to the anterior lip.

  • Gradually angle the tip of the blade towards the endocervical canal until about 15–20 mm of the endocervix is resected.
  • Remove the specimen, to be placed in the biopsy vial containing 10% formaldehyde.

  • Fulgurate the bleeding points on the cervix with a ball electrode using the pure coagulation current from the ESU. Use the spray mode of the ESU if possible.
  • Perform endocervical curettage and send the curetting for histopathology.
  • Apply Monsel’s paste to the raw area on the cervix.
  • Remove the tenaculum and the speculum.

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