A comparison of cold knife, CO2 laser, and electrosurgical loop conization in the treatment of cervical intraepithelial neoplasia.

Thirty patients with histologically confirmed high-grade squamous intraepithelial lesions (SIL) were treated by either cold knife, laser, or electrosurgical loop conization, all of which were performed under general anesthesia. The three methods were compared with respect to the immediate surgical complications, ease of performance, delayed complications, and quality of histologic specimens. The electrosurgical loop conization had decreased blood loss and reduced operative time and proved to be tissue sparing. There were no significant differences in the three groups in the persistence rates of cervical intraepithelial neoplasia (CN) after treatment. Histologic analysis revealed comparable coagulation artifact in the laser and electrosurgical loop groups that the cold knife group did not have. The endocervical component of the electrocautery showed extensive denudation and coagulation artifact that made recognition of CIN extremely difficult. We conclude that the electrocautery should be used only as an excisional method of the transformation zone for lesions well defined on the ectocervix, since it is unreliable if the lesion extends into the endocervix.