Conization of the cervix using harmonic scalpel.

Area of Science:

• Gynecology
• Surgical Technology
• Oncology

Background:

• Cervical intraepithelial neoplasia (CIN) is treated with conization, a procedure preserving reproductive function.
• Traditional methods like cold knife conization have been superseded by laser conization and loop electrosurgical excisional procedure (LEEP).
• Laser conization and LEEP present drawbacks including high cost, electrocautery artifacts, fragmented tissue excision, and hazardous smoke production.

Purpose of the Study:

• To evaluate the efficacy and safety of Harmonic Scalpel (HS) conization for CIN III treatment.
• To compare HS conization with conventional methods regarding complications, visualization, and histological assessment.

Main Methods:

• Eleven women diagnosed with CIN III underwent conization utilizing the Harmonic Scalpel (HS).
• The HS system employs ultrasonic mechanical vibrations for cutting and coagulation.
• Outcomes were assessed for complications, bleeding, visual field clarity, specimen integrity, and histological accuracy.

Main Results:

• HS conization demonstrated negligible bleeding and no intraoperative complications in the study group.
• Postoperative hemorrhage occurred in only one patient.
• The procedure provided a clear visual field, free from smoke, and allowed for ideal specimen resection, preserving histological integrity without heat or ultrasound artifacts.

Conclusions:

• Harmonic Scalpel conization effectively addresses the limitations of laser and LEEP procedures for CIN treatment.
• This ultrasonic method offers a safe, efficient, and visually advantageous approach to conization.
• HS conization represents a significant advancement in surgical management of cervical intraepithelial neoplasm.