konisering

Konisering, or conization, is a gynecological procedure in which a cone-shaped piece of tissue is removed from the cervix, including the transformation zone where cervical precancerous changes commonly occur. The aim is to obtain a tissue sample for histopathological examination or to treat high-grade cervical intraepithelial neoplasia (CIN 2/3) or early cervical cancer. The tissue can be removed with a cold knife (cold-knife conization), laser conization, or loop electrosurgical excision procedure (LEEP/ablation with electrosurgery). The procedure may be diagnostic (to determine invasion and margins) or therapeutic (to treat high-grade lesions).

Indications include abnormal cytology or high-risk HPV testing with suspicion of CIN 2/3, invasive cancer, or persistent high-grade lesions when treatment is indicated. It is also used when colposcopic assessment is inconclusive or when a microinvasive cancer is suspected and definitive staging is required.

The procedure is usually performed under local, regional, or general anesthesia and can often be done on an outpatient basis. The cervix is accessed with a speculum, and the cone is excised with appropriate instruments, taking care to achieve hemostasis. Specimens are sent to pathology to evaluate margins and invasion. Recovery generally involves a period of pelvic rest and avoidance of sexual intercourse and tampons for several weeks.

Complications can include bleeding, infection, cervical stenosis, or scarring that may affect future cervical function. There is an increased risk of preterm birth in subsequent pregnancies, and cervical insufficiency may occur in some cases. Follow-up involves careful review of histopathology results and appropriate surveillance or further treatment based on margins and staging.