Carbon dioxide laser surgery for abnormal cervical cell changes

Surgery Overview

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A carbon dioxide (CO2) laser beam is used to:

• Destroy (vaporize) abnormal cervical tissue that can be seen through a magnifying viewing instrument (colposcope).
• Remove abnormal tissue high in the cervical canal that cannot be seen through the colposcope. The CO₂ laser can be used to do a cone biopsy (see cone biopsy for abnormal Pap test).

Laser vaporization takes 10 to 15 minutes. The abnormal tissue is destroyed or removed, leaving normal tissue intact.

How it is done

Carbon dioxide laser surgery is usually done in your health professional's office, a clinic, or a hospital as an outpatient procedure (you do not have to spend the night in the hospital).

You will need to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an examination table with your feet raised and supported by footrests (stirrups). Your health professional will insert an instrument with curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined.

The procedure is usually done with a numbing medication injected into the cervix (cervical block). If a cervical block is used, an oral pain medication may be used in addition to the local anesthetic.

What To Expect After Surgery

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Most women are able to return to normal activity within 2 to 3 days after surgery. Recovery time will depend on how much was done during the procedure.

After laser surgery

• A watery vaginal discharge may occur for about 2 to 3 weeks.
• Sanitary napkins should be used instead of tampons for 2 to 3 weeks.
• Sexual intercourse should be avoided for 2 to 3 weeks.
• Douching should not be done.

When to call your health professional

Call your health professional for any of these symptoms:

• A fever
• Heavy bleeding (more than you would usually have during a menstrual period)
• Increasing pelvic pain
• Bad-smelling or yellowish vaginal discharge, which may indicate an infection

Why It Is Done

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Carbon dioxide laser surgery is done when:

• Abnormal cell changes found on a Pap test have been confirmed by colposcopy and cervical biopsy, and the abnormal cells are visible through the colposcope.
• Moderate to severe cell changes are found on a Pap test. If these abnormalities cannot be confirmed by colposcopy, cells may be collected from high up in the cervical canal by cervical biopsy. If the abnormal cells are high in the cervix, the CO₂ laser can be used to do a cone biopsy to remove abnormal tissue.

How Well It Works

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Carbon dioxide laser surgery is successful in destroying abnormal tissue in about 95% of cases when it is used to vaporize the tissue.^{1, 2} When it is used to remove a wedge of abnormal tissue, it is successful in over 93% of cases.²

Risks

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• After the surgery, a small number of women (less than 10%) may have significant bleeding that requires vaginal packing or a blood transfusion.³
• A few women may have some cervical bleeding up to 7 to 10 days after laser surgery.
• Infection of the cervix or uterus may develop (rare).
• Narrowing of the cervix (cervical stenosis) that can cause infertility may occur (rare).

What To Think About

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Carbon dioxide laser surgery is able to destroy or remove abnormal tissue that is too high in the cervix to be destroyed with cryosurgery.

A carbon dioxide laser can be used to perform a cone biopsy (conization) but is not used as frequently as other conization methods because:

• It requires more specialized training to perform.
• A larger amount of tissue is burned at the margin of the biopsy.
• It is more expensive.

If you have carbon dioxide laser surgery, you need regular follow-up Pap tests. You should have a Pap test in 4 to 6 months or as often as recommended by your health professional. Once several Pap test results are normal, you and your health professional can decide how often to schedule future Pap tests.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Mitchell MF, et al. (1998). A randomized clinical trial of cryotherapy, laser vaporization, and loop electrosurgical excision for treatment of squamous intraepithelial lesions of the cervix. Obstetrics and Gynecology, 92(5): 737–744.

2. Martin-Hirsch PL, et al. (2006). Surgery for cervical intraepithelial neoplasia. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

3. Nuovo J, et al. (2000). Treatment outcomes for squamous intraepithelial lesions. International Journal of Gynecology and Obstetrics, 68(1): 25–33.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Denele Ivins
Associate Editor	Pat Truman
Primary Medical Reviewer	Joy Melnikow, MD, MPH - Family Medicine
Specialist Medical Reviewer	Barbara S. Apgar, MD, MS - Family Medicine, Women's Health
Specialist Medical Reviewer	Ross Berkowitz, MD - Obstetrics and Gynecology
Last Updated	January 12, 2007