A comparison of loop electrosurgical excision, laser ablation, and cold-knife conization in relation to precise...

The purpose of this study is to compare loop electrosurgical excision, laser ablation, and coldknife conization for accuracy of excision in a model simulating the nulliparous uterine cervix.

Twenty obstetrics and gynecology residents excised or ablated specimens (n = 300) by using loop electrosurgical excision, laser, and scalpel. Preprepared specimens (bologna) were cut to simulate the adult, nulliparous cervix. These specimens were marked with templates to simulate cervical lesions. The accuracy of excision, time for excision, gender differences, and years in training were compared by using repeated measures from analysis of variance and t tests.

Comparisons showed loop electrosurgical excision was more precise than was laser (F = 4.58; df = 1,15; p < .049) or cold-knife conization (F = 15.63; df = 1,15; p = .001). Laser ablation produced more specimens that were too shallow, and cold-knife conization resulted in specimens that were too deep. No differences were found among postgraduate years of training, but gender differences were revealed. Loop electrosurgical excision took significantly less time (mean = 23 seconds, standard deviation = 11.4 seconds) than laser ablation (mean = 135 seconds, standard deviation = 55.7 seconds; F = 68.22; df 1,15; p = .0001)) or coldknife excision (mean = 105 seconds; standard deviation = 37.9 seconds; F = 85.48; df = 1,15; p = .0001).

Using this model, loop electrosurgical excision is more precise and faster than laser ablation or cold- knife conization. Resident surgeons may be more precise in excising cervical lesions with this modality.