LEEP PROCEDURE
LEEP stands for "Loop Electrosurgical Excision Procedure." It's a treatment that prevents cervical cancer. Your doctor may recommend a LEEP if your Pap test or a procedure called a colposcopy produced abnormal results.
This procedure uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP allows your doctor to remove abnormal cells and test them for cancer.
Here's a step-by-step of how it usually goes:
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The doctor will first numb your cervix with local anesthesia.
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A speculum will be inserted into your vagina to hold it open, and the doctor will use a colposcope (a special magnifying instrument) to look at your cervix. The colposcope itself doesn't go inside your vagina.
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A vinegar-like solution may be applied to your cervix to make the abnormal cells more visible.
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The doctor will then use the electrified wire loop to remove a thin layer of abnormal cells from your cervix.
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The removed tissue will be sent to a lab for further examination.
Anesthetic Implications for Leep Procedure
Anesthesia type: General, local anesthesia, neuraxial block
Airway: LMA or ETT
Preoperative:
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Patients are generally young
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If pregnant, perform RSI induction
Intraoperative:
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A thin wire loop is inserted into the vagina
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An electric current is used to remove a wedge of the cervix
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A local anesthetic and epinephrine solution may be injected (may increase HR and BP)
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Position: lithotomy position, slight Trendelenburg with arms extended on armboards bilaterally
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Duration: 30-60 minutes
Postoperative:
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Pain management
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PONV prophylaxis
Complications:
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Perforation of the uterus
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Bleeding
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Infertility
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Nerve injury from lithotomy position
Sources:
Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).
Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.