Laser surgery for cervical intraepithelial neoplasia: principles and results

Four hundred twenty-nine consecutive cases of cervical intraepithelial neoplasia were managed by one of three techniques of carbon dioxide laser surgery: dome-shaped vaporization of ectocervical lesions, cylinder-shaped excision of endocervical disease, or a combination of the two in the case of ectocervical disease that extended into the lower cervical canal. Ninety-two patients (21.5%) had grade 1, 137 (31.9%) had grade 2, and 200 (46.6%) had grade 3 cervical intraepithelial neoplasia. The success rates subsequent to one surgical intervention were 97.8% for grade 1, 94.9% for grade 2, and 94.5% for grade 3 of the disease. Success for the entire patient population was 95.3% after the first treatment. A second treatment was required in 20 cases: 18 laser procedures and two hysterectomies. The overall success of laser surgery (one or two procedures) approached 100%. Complications were negligible. These findings suggest that these techniques are very effective in eliminating cervical intraepithelial neoplasia of all degrees when a planned approach is followed.