June 18th, 2018

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Comparison of Loop Electrosurgical Excision Procedure Using a Ring-Shaped Loop Versus a Right-Angled Triangular Loop
Authors:  Seung-Hyuk Shim, M.D., Ph.D., Sun Joo Lee, M.D., Ph.D., Seung Woo Yang, M.D., Ji Young Lim, M.D., Soo-Hyun Cho, M.D., Wook Youn Kim, M.D., Ph.D., Hee Sun Kim, M.D., Ph.D., and Soo-Nyung Kim, M.D., Ph.D.
  OBJECTIVE: To compare the resection margin (RM) status and postoperative severe hemorrhage using different loop electrosurgical excision procedure (LEEP) techniques for cervical intraepithelial neoplasia (CIN) 2/3 treatment.

STUDY DESIGN: We retrospectively reviewed 278 patients who underwent LEEPs for CIN 2/3 treatment at our institute between 2005–2014. In type A surgery (N=148), a ring-shaped loop was used. If the first pass failed to remove the entire lesion, separate loop excisions for the intracervical portion were performed. In type B surgery (N=130), a right-angled triangular loop in a single pass was used. Surgical outcomes and postoperative severe hemorrhage were compared between the two groups. Logistic regression analysis was performed to identify the independent predictors of RM status.

RESULTS: The mean LEEP depth was larger after type A surgery (2.2 vs. 2.0 cm, respectively; p=0.04). Type B surgery showed lower rate of 30-day postoperative hemorrhage (13.8% vs. 26.4%, p<0.05) and higher rate of negative RM (68.9% vs. 82.3%, p<0.05). Multivariate analysis identified the surgery type (p=0.01, OR=0.45 [0.24–0.83]) and a postoperative pathological diagnosis of CIN3 (p=0.01, OR=2.53 [1.22–5.26]) as independent risk factors for positive RM.

CONCLUSION: LEEPs using a right-angled triangular loop could reduce positive RMs.
Keywords:  cervical intraepithelial neoplasia, gynecologic surgical procedures, LEEP, loop electrosurgical excision procedure, postoperative hemorrhage, resection margin, surgical margins
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