The procedure to surgically remove part of the cervix is ​​called conization. The goal is to remove lesions that can potentially progress to cervical cancer. In which cases to practice it? What is the process? All the answers in this guide.

Conization is a surgical technique that involves removing a portion (of variable volume) of the cervix in the shape of a cone, hence the name conization. The procedure is most often performed when there are cervical abnormalities called dysplasias. Indeed, without treatment, these lesions can progress, after several years, to true cancer of the cervix.

Conization is indicated in the following cases:

• Discovery of high-grade dysplasia (precancerous lesion) or micro-invasive cancer of the uterine cervix during a cervico-vaginal smear then during a biopsy performed under colposcopy;
• Discovery of cervical dysplasia during a cervico-vaginal smear, but colposcopy biopsy is not possible.

Left untreated, these lesions can lead to real cancer of the cervix.

Most of the time, the operation is performed under local anesthesia of the cervix, locoregional (epidural) or general, depending on the choice of the person and the decisions of the surgeon and the anesthesiologist. 

When the risk of bleeding is high, the procedure will be performed in the operating room under general anesthesia. This is performed by a gynecologist-surgeon. Conization is carried out by natural means, by accessing the cervix through the vagina, after placing a speculum. There is therefore no visible external scar. 

The gynecologist begins by performing a new colposcopy (visual observation of the cervix) in order to locate the limits of the lesion to be removed. The height and width of the conization piece are limited to the size of the lesions and the person’s desire for pregnancy. On the one hand, to remove the entire lesion, the conization must protrude at least 3 mm from the periphery of the abnormal zone and be sufficiently deep. 

In case of pregnancy project

On the other hand, in the event of a pregnancy project, it is necessary to be the most far-sighted in order to preserve the obstetrical future. A new colposcopy will be performed at the very beginning of the operation and will allow the lesions to be delimited. 

The procedure can be performed using an electric scalpel or using a laser. Persistence of small bleeding for several days is usual.

The purpose of a conization is twofold:

• Remove the dysplastic (precancerous) lesion of the uterine cervix in order to rid the person of it and therefore prevent its progression to cervical cancer;
• Analyze the fragment taken more completely: diagnostic (know precisely the exact type of lesions so that there is no discrepancy between the preoperative biopsies and the final analysis and thus specify its extent), therapeutic (check that the complete removal was not enough to prevent progression to cancer).

Like every surgical procedure, conization involves certain risks which are certainly rare but which must be known:

• Bleeding: risk of bleeding occurring immediately postoperatively or remotely within 10 days. The occurrence of hemorrhage may require the placement of a vaginal wick (tampon) by the surgeon or hemostatic points or more rarely, reoperation. Its occurrence should therefore require you to consult your doctor;
• Risk of infection: onset by smelly vaginal discharge, pelvic pain and fever;
• Cervical stenosis: tightening of the cervical canal. It may exceptionally require a new intervention to increase the canal. It can also interfere with or prevent the periods from passing, make monitoring of the cervix difficult and therefore affect the quality of the surveillance smears, cause difficulties for a successful pregnancy, interfere with the opening of the cervix at the time of delivery ;

• The risk of miscarriage and premature delivery (risk of spontaneous miscarriage, premature rupture of membranes, premature delivery and cesarean section);
• Risks associated with anesthesia (allergy, infection, etc.).

In order to reduce the risk of bleeding, it is recommended:

• Not to take a bath (shower allowed); 
• Do not go to the swimming pool; 
• Do not use periodic tampons; 
• Do not take the plane;
• Do not have sex for 1 month.