Loop electrosurgical excision procedure (LEEP) under local anesthesia: a retrospective analysis of 435 subsequent...

Area of Science:

• Gynecology
• Surgical Quality Improvement
• Anesthesiology

Background:

• Loop electrosurgical excision procedure (LEEP) is a common treatment for cervical dysplasia.
• General anesthesia (GA) has traditionally been used for LEEP, potentially leading to increased costs and recovery times.
• Transitioning to local anesthesia (LA) for LEEP may offer benefits in terms of patient experience and resource utilization.

Purpose of the Study:

• To evaluate a quality assurance program for transitioning LEEP procedures from general anesthesia (GA) to local anesthesia (LA).
• To assess perioperative pain levels, patient satisfaction, and resection margins following LEEP performed under LA.
• To determine the feasibility and success of establishing LEEP in LA as a new standard of care.

Main Methods:

• A single-center retrospective analysis was conducted on patients undergoing LEEP from January 2021 to June 2024.
• 435 patients treated with LEEP in LA were surveyed postoperatively regarding pain (Numeric Rating Scale) and satisfaction.
• Clinical data, including resection margins and complications, were extracted from electronic health records.

Main Results:

• The mean perioperative pain score was 1.3 (SD 1.9).
• A R0 resection rate of 81.4% was achieved, with R1 rates of 9.7% (ectocervix) and 8.3% (endocervix).
• 95.3% of patients expressed willingness to choose LEEP in LA for future procedures, indicating high satisfaction.

Conclusions:

• The implementation of LEEP in LA was successful, establishing a new standard of care with high R0 resection rates and excellent patient satisfaction.
• The study supports the transition from GA to LA for LEEP procedures in managing cervical dysplasia.
• LEEP in LA is a safe and effective alternative, demonstrating positive patient outcomes and high acceptance.