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

Author: Courtney Misher, MPH, BS R.T.(T)
Last Reviewed: December 08, 2023

Loop Electrosurgical Excision Procedure (LEEP) and Cold Knife Cone (CKC)

If you have precancerous cell changes in your cervix tissue, you may need to have it removed with surgery. This will help lower your risk of getting cervical cancer. Your cervix is the small canal that connects your vagina and uterus. The two most common ways to remove tissue from the cervix are a Loop Electrosurgical Excision Procedure (LEEP) and a Cold Knife Cone (CKC).

How is a LEEP done?

During a LEEP, you will lie on your back with your legs in stirrups. Like a pelvic exam, your provider will use a speculum to see your cervix. A LEEP is often done in your provider's office using a local anesthetic to numb your cervix and manage your pain. Your provider may also put a vinegar solution on your cervix to see the abnormal cells better.

An electrically charged wire loop is then used to remove the abnormal tissue. After the tissue is removed, your bleeding will be stopped by cauterizing (burning) and/or putting a paste on your cervix. A LEEP may also be called a large loop excision of the transformation zone (LLETZ).

How is a CKC done?

A CKC is done in an operating room using general anesthesia, so you will be sleeping, and you will not feel any pain. During a CKC, you will be on your back and your provider will use a speculum to see your cervix. Your provider will remove a small, cone-shaped piece of your cervical tissue using a scalpel (surgical knife) or a laser. Typically, during a CKC more tissues are removed, which is why general anesthesia is used instead of a local anesthetic. This is also why the recovery time for a CKC is longer.

What can I expect after the procedure?

You will go home after a LEEP or CKC. For most, the recovery after a LEEP is quick and you can go back to normal activity in 1 to 3 days. For a CKC, you can often go back to normal activity after 1 week.

For several weeks after a LEEP or CKC, you will need to not have sexual intercourse, use tampons, or douche. Your provider will let you know when you can resume these activities.

Some common side effects include:

  • Mild cramping or pain.
  • Light bleeding or pink, watery vaginal discharge, or spotting.
  • Brown/black vaginal discharge. If you had a LEEP this can be from the paste applied to your cervix to stop the bleeding.

When should I call my healthcare team?

As with any surgery, there is a risk of infection. After your LEEP or CKC procedure, you should contact your healthcare team right away if you have any of the following:

  • 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.
  • Chills.
  • Nausea/Vomiting

If you have any questions about having a LEEP or CKC, talk to your provider. They will be able to answer any questions you may have and give you more details.

Cone biopsy: Medlineplus medical encyclopedia. MedlinePlus. (2022, January 10).

Cooper DB, Carugno J, Dunton CJ, et al. Cold Knife Conization of the Cervix. [Updated 2023 Oct 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:

Loop Electrosurgical Excision procedure (LEEP). ACOG. (2023, April).

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