Checklist for Cervical Conization or LEEP procedure

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This checklist is part of the Gynsurgery guidelines used in an educational setting for residents in Ob-Gyn. The pdf form of the Cervical Conization or LEEP Procedure Checklist may not contain the latest changes

Preoperative Checklist

  1. ___ Check HIV status of individual prior to procedure (predict recurrence of dysplasia)
  2. ___ Administer prophylactic antibiotics (prevent postoperative cervical infection)

Intraoperative Checklist

  1. ___ Repeat colposcopy in operating room suite or use Lugol's solution to redefine the ectocervical extent of the lesion (prevent leaving residual tissue dysplasia)
  2. ___ Use paracervical block (approximately 6 ccs) with 1% xylocaine (prevent pain during procedure for office LEEP, laser)
  3. ___ Inject about 10 cc's of vasopressor solution (e.g., xylocaine 1% with epinephrine or pitressin 10 units in 50 cc's) intracervically (prevent bleeding)
  4. ___ For LEEP, avoid touching vaginal side walls with LEEP probe (prevent pain during procedure for office LEEP, laser)
  5. ___ For CKC, place traction on cervix with lateral sutures or tenacula (prevent bladder injury/bowel injury)
  6. ___ Excise specimen tissue parallel to the ectocervical surface and endocervical canal so as not to remove excessive cervical support tissue (strive for inverted T-shaped specimen rather than cone-shaped specimen) (prevent premature labor/cervical incompetence)
  7. ___ Carry the cephalad extent of the excision into the endocervix past the extent of the visble lesion or up to the internal os if extent not visualized (prevent leaving residual tissue dysplasia)
  8. ___ Perform endocervical curettage following excision of the tranformation zone (prevent leaving residual tissue dysplasia)
  9. ___ Use Monsel's solution for hemostasis instead of suture if possible (prevent cervical stenosis) (prevent bleeding)
  10. ___ Avoid excessive cautery of the cervical excision bed (prevent cervical stenosis)

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