An electrical scalpel conization versus Shimodaira-Taniguchi conization procedure for cervical intraepithelial neoplasia

Abstract

The incidence of cervical intraepithelial neoplasia(CIN) among reproductive-aged women has increased in Japan. Cervical conization is commonly applied for local cervical treatment to preserve fertility. The Shimodaira-Taniguchi (S-T) conization procedure is widely used in Japan. S-T conization uses a high-frequency current and a triangular probe with a linear excision electrode to remove cervical tissue as a single informative specimen. However, alternative of an electrosurgical scalpel (ES) has the advantage of adjusting the surgical margin to the transformation zone in order to preserve the maximum amount of healthy cervical tissue with good hemostasis. The aim of this study is to retrospectively analyze data regarding surgical margin status, perioperative adverse events, cervical stenosis, and preterm birth between S-T and ES.Between January 2009 and December 2014, the medical records of 1166 patients who were diagnosed as CIN II, III, or stage 1a1 cervical cancer and who were treated with conization in 7 hospitals in Gunma Prefecture, Japan were enrolled for this retrospective study. The clinicopathological data was analyzed to statistically compare outcome between S-T and ES conization.There was no difference for age or post-operative follow-up period between ES and S-T treatments. However, positive surgical margins were significantly less frequent in patients who were treated with S-T than in those treated with ES, resulting in a reduced incidence of re-treatment for S-T in comparison with ES patients. In perioperative adverse events, S-T had more patients who were administered antibiotics. The incidence of preterm delivery and cervical stenosis did not differ significantly between the groups.We demonstrate here that S-T is an alternative procedure for cervical conization with a low risk of recurrence and acceptably low rate of adverse events such as cervical stenosis and preterm delivery. The results of this study can provide useful information for future management of patient with cervical intraepithelial neoplasia.

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

“…A meta-analysis of 35,109 patients with any grade CIN or invasive cancer found that 23% had positive surgical margins 22 . The rate of positive surgical margin involvement in the LEEP varied from 22% to 33.8%, in CKC from 13% to 22.3%, and in ESC from 4.7% to 25.7% 10,21,23–25 . It has been confirmed that a conization depth less than 10 mm might be a risk factor that predicts endocervical resection margins and had the highest sensitivity (100%) among the other factors including cone volume and cone base surface 26,27 .…”

Modified method of cervical conization with hybrid use of a cold knife and an electric knife for high-grade squamous intraepithelial lesions

“…An electronic knife coagulates small blood vessel simultaneously when incising. 13 With less bleeding during incising, a clear surgical field can be maintained, which in turn facilitates a precise incision, and consequently, less bleeding. Second, the purposeful manipulation of the cervix and the change in the cone shape may also be important factors.…”

“…5,22 Kigure et al reported that more conservative conization, such as shallow coin-shaped conization, could achieve favorable obstetric outcomes. 13 A smaller amount of the cervical stroma was excised with our modified method, which may be a better alternative in young patients with the desire of future fertility. A thermal artifact remains the main concern of the LEEP.…”

“…10 However, thermal artifacts and fragmentation of specimens in this procedure may result in difficulty in pathological interpretation. 11,12 Other variant modifications with only an electric knife or a pure cutting current or harmonic scalpel have also been reported with reduced thermal artifacts [13][14][15] Furthermore, because the extent of excised tissue is related to postoperative morbidities, the excised cone in LEEP and other procedures gradually transforms from a typical "cone" to a more shallow "coin" shape. 16,17 On the basis of these previous studies, we comprehensively modified our method of cervical conization with the aim of incorporating the advantage of the LEEP into the traditional procedure.…”

Can prophylactic transvaginal cervical cerclage improve pregnancy outcome in patients receiving cervical conization? A meta-analysis

“…This meta-analysis suggested that prophylactic transvaginal cerclage following conization increases the risk of preterm birth and PROM. In France, a historyindicated cerclage is not recommended for women with only a history of conization [37]. In another study, Kaye and Giraldo-Isaza considered that the increasing risk of PROM following cervical cerclage may related to the risk of ascending infection [38,39].…”