Surgical Procedures: LEEP and Cold Knife Cone (Cone Biopsy)

What is a Loop Electrosurgical Excision Procedure and how is it performed?

A Loop Electrosurgical Excision Procedure (LEEP) is the removal of abnormal cells on the uterine cervix (the bottom part of the uterus). This is done either in a provider’s office or operating room, often using a local anesthetic to numb the area and control pain. During a LEEP, an electrically charged wire loop is used to remove abnormal cells of the cervix. Bleeding is stopped using electrocautery (an electrical current that causes heat) and/or a paste.

A LEEP may also be called a large loop excision of the transformation zone (LLETZ).

What is a Cold Knife Cone and how is it performed?

A Cold Knife Cone (CKC) is the removal of a cone-shaped piece of cervical tissue containing abnormal cells, using a scalpel or laser. This procedure is done in the operating room using general or regional anesthesia for pain control. A CKC is used to remove pre-cancerous and, at times, cancerous cells from the cervix.

What are the risks of having a Loop Electrosurgical Excision Procedure or Cold Knife Cone?

As with any surgery, there are risks and possible side effects. These can be:

LEEP

• Heavy vaginal bleeding.
• Infection.
• Cervical stenosis or narrowing causing menstrual and/or fertility problems.

CKC

• Bleeding.
• Damage to nearby organs (bladder, ureters, bowel).
• Infection.
• Blood clot and/or pulmonary embolism.
• Cervical scarring and/or incompetent cervix. An incompetent cervix is weakening of cervical tissue that can lead to issues during pregnancy. 

What is recovery like?

Following a LEEP procedure:

• Pink, watery vaginal discharge.
• Mild cramping.
• Brown/black vaginal discharge, which is caused by the paste applied to the cervix to stop bleeding.

For most, recovery is quick and normal activities can be resumed within 1 to 3 days.

Symptoms to be reported to your healthcare team after LEEP include:

• Heavy vaginal bleeding and/or bleeding with clots.
• New or worsening pain.
• Foul-smelling vaginal discharge.
• Fever. Your care team will tell you at what temperature they should be contacted. 

Following a CKC procedure:

• Intermittent cramping.
• Brown vaginal discharge or spotting.

Symptoms to be reported to your healthcare team after CKC include:

• Fever. Your care team will tell you at what temperature they should be contacted. 
• Chills.
• Foul-smelling vaginal discharge.
• Heavy vaginal bleeding and/or bleeding with clots.
• New or worsening pain.
• Nausea/Vomiting.

What will I need at home?

• Sanitary pads for vaginal bleeding/discharge
• Thermometer to check for fever, which can be a sign of infection.