The effects of different instruments and suture methods of conization for cervical lesions

This study is to compare the surgical outcomes of patients undergoing cold knife conization (CKC) versus electrosurgical conization (ESC). Among 10,086 patients in a single center admitted between January 2000 and January 2019, CKS or ESC was used for grade 3 cervical intraepithelial neoplasia (CIN3) or more severe lesions. Modified Sturmdorf or Figure-of-eight sutures were applied after conization. A regression model was used to determine the risk factors for margin involvement and short-term post-operative complications. In total, 7275 (72.1%) and 2811 (27.9%) patients underwent CKC and ESC, respectively. Women who underwent ESC were older and had a higher risk of margin involvement and endocervical glandular involvement than those who underwent CKC in univariate analysis. However, in the multivariate analysis, age (odds ratio [OR] 1.032, 95% confidence interval [95% CI] 1.025-1.038) and glandular involvement (OR 2.196, 95% CI 1.915-2.517) were the independent risk factors associated with margin involvement, but the incision methods used caused no significant difference. Modified Sturmdorf sutures and Figure-of-eight sutures were applied in 3520 (34.9%) and 6566 (65.1%) patients, respectively. The modified Sturmdorf sutures was the only risk factor associated with wound hemorrhage (OR 1.852, 95% CI 1.111-3.085) after adjusted with other epidemiological and surgical factors. Various incision or suture methods had similar risk of cervical stenosis. Therefore, ESC is an acceptable alternative to CKC for the diagnosis and treatment of cervical lesions regarding the pathologic accuracy and integrity, and short-term safety. Modified Sturmdorf sutures increased the risk of wound hemorrhage compared with Figure-of-eight sutures.