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.
References
The American College of Obstetricians and Gynecologists. 2020. Loop Electrosurgical Excision Procedure (LEEP). https://www.acog.org/womens-health/faqs/loop-electrosurgical-excision-procedure
MedLine Plus. 2020. Cone Biopsy. https://medlineplus.gov/ency/article/003910.htm