Cervical laser cautery

1. Laser burnning of cevix
[Indications]
1. Chronic cervicitis.
2. Cervical endometriosis.
3. Mild to moderate cervical intraepithelial neoplasia.
[Contraindications]
1. Acute vulvar, vaginal, cervical or (and) pelvic inflammatory disease.
2. Severe cervicitis, malignant transformation is not excluded.
[Preoperative preparation]
1. Routinely perform cervical smear examination to find cancer cells, and those with suspicious clinical and cytological examinations should undergo cervical biopsy.
2. People with acute genital inflammation should take anti-inflammatory treatment first.
3. No sex life for 3 days before surgery.
[Selection of the timing of surgery]
Within 3 to 7 days after the menstrual period; 1 month after the placement of the IUD; more than half a year after giving birth, and menstruation returns; after 2 months after miscarriage; breastfeeding is not suitable for this operation.
[Surgical steps and technical points]
1. Body position: lithotomy position.
2. Disinfection: Routine disinfection of the vulva, vagina and cervix.
3. Cervical cauterization: use co2 laser, wavelength 10.6μm, output power 20-30w continuously adjustable, the distance between the cutter head is 2-5cm from the lesion, the diameter of the spot is 0.3-0.5cm, aiming at the lesion tissue for scanning vaporization, from bottom to top, Repeat the scan from the outside to the inside, the boundary is about 2mm beyond the lesion, and the cautery depth is about 2-3mm.
4. Cervical gland retention cyst cauterization: First, use a laser to make a small hole in the center of the cyst, squeeze out the viscous cyst fluid with tweezers, and then vaporize the entire cyst wall.
5. Surgical wound treatment: Disinfect the cervix again.
[Features of this technique]
1. Laser cauterization uses high-energy light energy to immediately cauterize and vaporize the tissue, and the operation time is short.
2. It can accurately limit the tissue damage area, and accurately grasp the tissue penetration depth by controlling the action time of the laser beam.
3. Compared with cryosurgery, postoperative vaginal discharge is less.
[Postoperative care]
1. Routinely give antibiotics and hemostatic drugs for 3 days.
2. Within two weeks, there will be a lot of light red watery fluid discharged from the vagina, which is a normal phenomenon and does not need to be treated.
3. No sex life within two months.
4. Two-month review, if the wound is not completely healed, a second superficial cautery can be performed.
[Common complications and treatment]
1. Bleeding is more common. The predilection site is about 6 o’clock on the posterior lip of the cervix. For a small amount of bleeding, a large cotton swab can be used to stop the bleeding or the laser beam can be adjusted to > 2mm, and the bleeding foci and surrounding areas can be cauterized to coagulate the blood vessels.
2. Postoperative pelvic infection: manifested as lower abdominal pain, cervix covered with green-black material, foul-smelling secretions, uterine tenderness on anal examination, and local or systemic anti-inflammatory treatment is required.
3. Postoperative cevical stenosis: use vascular forceps to separate the membrane-like material at the adhesion site, and perform cervical dilation if necessary.