LLETZ make it simple: Anxiety, pain and treatment outcomes with outpatient large loop excision of the transformation zone under local anaesthesia

Abstract

Background: Large loop excision of the transformation zone (LLETZ) is the preferred treatment for cervical intraepithelial neoplasia due to its effectiveness and ability to be performed in an outpatient setting under local anaesthesia (LA).Although current guidelines recommend that most LLETZ can be performed under LA, there is paucity in clinical data of patients' perspectives of outpatient LLETZ.Aim: Determining patient acceptability of outpatient LLETZ through assessment of anxiety and pain scores, and comparing treatment outcomes with current standards in terms of margins status, negative histology, short-term morbidity rates and follow-up attendance. Materials and Methods:This study was conducted at a tertiary hospital over two years (2014)(2015)(2016). Patients undergoing outpatient LLETZ completed a three-part questionnaire (before, immediately after and 4-6 weeks post-procedure). Results:One hundred and five patients underwent outpatient LLETZ. Mean pain score was 2 (range 0-8). Pre-procedure anxiety was common but most resolved post-procedure. Women who did not have a prior LLETZ discussion were more likely to report moderate-severe anxiety levels pre-procedure, compared with women who did (odds ratio 3.00, 95% CI 1.11-8.09, P = 0.030). There were no differences found in pain scores when comparing pre-procedure anxiety levels, prior discussion of LLETZ or mode of anaesthesia. Specimen margins were involved in 42.9%. No association was found between positive cervical margin status and age, pre-procedure anxiety or post-procedure pain scores. Most patients were satisfied and attended follow-up appointments. Conclusion:Large loop excision of the transformation zone under LA is a well-tolerated procedure with high satisfaction and follow-up rates. Clinicians need to initiate early discussions regarding treatment to minimise procedure-related anxiety. K E Y W O R D S anaesthesia, anxiety, cervical intraepithelial neoplasia, large loop excision of the transformation zone, pain

LLETZ Procedure in an Outpatient Setting: Applicability and Cost-Effectiveness

“…Therefore, local anesthesia provides a smooth and painless operation and adequate analgesia in the postoperative period. Similar results have been reported by other authors [4].…”

“…The most commonly used excision techniques are electroconization, scalpel conization, laser conization, and electrical loop excision (LLETZ -large loop excision of transformation zone). The latter is characterized by minimal blood loss, high effi ciency, low cost, low incidence of complications, and the possibility to perform in an outpatient setting [2][3][4][5].…”

Patient expectations and experiences with loop electrosurgical excision procedure in inpatient and outpatient settings

“…Pre‐procedure anxiety was universal, with the high rate of anxiety in this study reflecting the literature 16 . Women having outpatient LEEPs had higher levels of anxiety, and the most common reason reported for this anxiety was concern about pain.…”

Evaluation of surgery indication of cold knife conization and anatomopathological reports in patients with cervical squamous intraepithelial lesion or cervical cancer

“…From the reproductive perspective point of view, both methods are associated with worse obstetric outcomes, but cold knife conization has a higher correlation with premature rupture of membranes, premature birth, and low birth weight (Kalliala et al, 2020;Teixeira et al, 2018). Therefore, LLETZ has been gaining more attention for being a low-cost outpatient procedure performed under local anesthesia, which is relatively safe with low complication rates (Yap, Nathan & Farrell, 2020). It is important to highlight that LLETZ enables reliable histopathological diagnosis only if there is no fragmentation of the excised specimens, since the extensive thermal injury makes it difficult to interpret its margins (Teixeira et al, 2018;Sparić et al, 2016).…”