Example

Most loop electrosurgical procedures can be performed under local anesthesia in an outpatient setting. The patient is placed in a lithotomy position and is attached to a grounding pad. An insulated speculum, connected to smoke-evacuator tubing, is used to prevent electric shock, which can occur if a noninsulated metal speculum is touched inadvertently by an active loop. For local anesthesia, the doctor injects 2-5 mL of lidocaine with epinephrine at the 3-, 6-, 9-, and 12-o'clock positions 1-2 mm beneath the surface of the cervical epithelium using a 25-gauge spinal needle. The use of epinephrine (or dilute vasopressin) is crucial to prevent intraoperative bleeding that could obscure the field of vision. If a patient is unable to relax, a safer plan may be to perform the procedure under general anesthesia because accidental burns of the vaginal wall can occur in patients who move during the procedure.

The loop size, usually 1.5-2 cm in width and 0.8-1.0 cm in depth, should be appropriate to remove the entire transformation zone with a 3-mm margin in one pass. In the first pass, tissue is ablated to a depth of approximately 1 cm. Using a 1-cm by 1-cm loop, more of the endocervical canal can be excised in a second pass from the crater base. Once the cervix is adequately exposed, LEEP procedures can be performed with extreme rapidity, usually in less than 1 minute. The loop can be directed in a transverse direction (eg, from the 9- to 3-o'clock position) or anteroposteriorly. Following the loop excision, the surface of the cervix appears raw. Painting it with Monsel solution can usually control oozing. Larger bleeders should be cauterized with a ball cautery tool.

• Leep procedure word help please...see msg - jss
  • speculum - seabee wife
  • LEEP - Lilly
  • anyone have a reference site??? - jss
    • Example - Lilly
      • thanks!!! - jss

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