Cone Biopsy

Cone Biopsy / Leep of the Cervix / Laser Treatment

What Is A Cone Biopsy?

A cone biopsy or LEEP is a minor surgical procedure. It involves the removal of a cylindrical or cone-shaped piece of the cervix in which the abnormal cells are located. Pathological examination will then confirm the diagnosis and ensure that all the abnormal cells have been removed.

Why Is It Performed?

A cone biopsy or LEEP is performed when:

• There are precancerous changes of the cervix.
• The entire abnormal area cannot be fully seen at colposcopy. This may occur when the abnormality extends into the cervical canal. This is the canal that leads from the vagina through the cervix and into the uterus.
• The PAP smear repeatedly shows abnormal cells although the colposcopy reveals normal results. This may mean that the abnormal cells are from the endocervical canal.
• The doctor is concerned that the abnormal cells show signs of a very early cancer.

How Is It Performed?

You will be positioned as for a gynaecological examination.

For pain relief, a local anaesthetic (during which you will remain awake) or a general anaesthetic (during which you would be asleep for the entire procedure) will be administered.

In general, the procedure is performed via one of 3 methods:

• With a heated electrical loop wire - This is known as LLETZ (large loop excision of the transformation zone) or LEEP (loop electrosurgical excision)
• With a surgical knife
• With a laser

There is usually some mild discomfort after the procedure. A brown-coloured paste (Monsel's solution) may be applied to arrest the bleeding.

A vaginal pack may also be inserted temporarily to stop any bleeding and a tube (catheter) may be placed in the bladder to ensure that it remains empty until the gauze is removed. Painkillers and antibiotics may be prescribed after the procedure.

Where Is It Performed?

This may be performed at:

• The Colposcopy Clinic at the Gynaecological Cancer Center (GCC) (Level 1)
• The Day Surgery Centre (Basement 1)
• The Operating Theatres (Level 2)

What Do I Need To Know Before The Procedure?

The procedure may be claimed up to a limit under the Medisave Scheme.

Your procedure cannot be performed during your period. Do call the GCC to postpone the procedure if this occurs.

Your doctor may prescribe antibiotics prior to the procedure.

If you have an IUCD - situ, this will be removed during the procedure. Do use alternative forms of contraception during this period.

For procedures at the Day Surgery or Main Operating Theaters:

• Fasting may be required
• A partner, friend or relative will need to accompany you on discharge from the hospital
• Medical leave will generally be provided to enable you to rest and recover at home

What Can I Expect On The Day Of The Procedure?

LEEP / LLETZ Biopsy

Register at the GCC counter.

Your blood pressure and pulse will be checked by our nurses.

The doctor will then administer a local anaesthetic before performing the procedure, which may be viewed on a television screen beside your couch.

There may be mild discomfort during the procedure, which will last approximately 15 minutes.

After the procedure, you will be accompanied to another room to rest. Our nurses will monitor you for approximately 30 minutes before discharging you from the clinic.

Cone Biopsy

Register at the Day Surgery counter (Basement 1) or Women's Admissions (level 1) (if you require admission for the day).

An anaesthetist will discuss the type of pain relief available with you in the operating theatre.

The procedure will last approximately 30 minutes.

You will then be monitored by our nurses at the recovery area prior to discharge from the Day Surgery centre or prior to transfer to the hospital wards if you have been admitted for the day. 

What Are The Risks Associated With A LEEP Cone Biopsy?

The procedures are relatively safe. However, as with all surgeries, complications may occur. These include bleeding, infection, and injury to surrounding tissues. In rare cases, narrowing or a weakening of the cervix may occur - both of which may cause complications during pregnancy.

Laser Treatment

What Do I Need To Know About Laser Surgery?

Laser surgery is a safe and effective method available for various gynaecological conditions of the vulva, vagina and cervix. The laser used is called a carbon dioxide (CO2) laser.

The laser produces a beam of intense light not visible to the eye. This beam is directed by the surgeon on the affected area as he views the area through an operating microscope. The laser beam instantly evaporates diseased cells while causing little or no damage to the surrounding healthy tissues. Healing is thus rapid following laser surgery. The procedure usually requires anaesthesia.

What Can I Expect After The Procedure?

After surgery, you may experience:

• Mild abdominal cramps similar to menstrual cramps. This may last for a few hours and is easily relieved with painkillers which your doctor may prescribe.
• Vaginal discharge which may last for up to 6 weeks. This is typically a yellow / brown discharge and may be blood stained. You are advised to wear a liner or sanitary pads.
• The timing of your next menstrual period should not be affected.

What Special Precautions Will I Need To Take?

1. Activities
   • You may want to rest after the procedure.
   • You may return to work or your normal activities the following day.
   • Avoid strenuous activities.
   • Avoid swimming for a month.
2. Diet
   You may continue with a normal diet.
3. Medication
   Your doctor may prescribe a course of antibiotics.
4. Sexual activity
   You are advised to abstain from sexual intercourse for a month following the procedure.
5. Hygiene
   • Avoid tub baths, take showers instead.
   • Avoid douching or using vaginal medications unless otherwise specified by your doctor.
   • Do use sanitary pads until the bleeding stops. Avoid tampons.

It is normal to have slight bleeding or brownish vaginal discharge for 2- 3 weeks following the procedure. Consult your doctor if you experience:

• Heavy bright red vaginal bleeding (similar to your period) within the first 3 weeks of the operation - such bleeding typically occurs within the first 48 hours of the procedure or 10-14 days after the surgery. It may of course be due to your period. It would however be safer to consult your doctor to exclude bleeding from the wound site.
• Foul-smelling vaginal discharge within the first 3 weeks of the surgery as this may be due to an infection.
• Fever
• Severe abdominal cramps not relieved by painkillers.

You can seek consultation at the Gynaecological Cancer Centre (Level 1) or at our 24-Hour O&G Clinic (Basement 1).

What About Follow-Up Visits?

After treatment, follow-up visits are necessary to ensure that all the abnormal areas have been treated and that the cervix has healed well. To ensure that you remain well, regular visits are advised.