You might not want to read this if you are really squeamish.
I was learning to do LEEPS from my partner in Colorado over 20 years ago.
She was precepting me through a certain number.
1. Have the patient sign a consent for surgery, give the routine warnings, risks and benefits. Have them undress from the waist down. Patient prone on exam table with feet in stirrups.
2. Insert speculum into vagina.
3. Try to focus the damn colposcope. This is a microscope on a stand that can focus from a distance, so that you can see what the hell you are doing in the vagina. This is the most time consuming activity, at least for me. A full time gynecologist probably gets really really quick.
4. Use the giant Q tips to gently put an acidic solution on the cervix. This almost never stings.
5. Look through the colposcope. Look at the pathology report from the biopsies. You are looking for the area that lights up white. If you are doing a LEEP, the person has an abnormal pap smear and then had a colposcopy and has stage III or stage IV CIN. CIN is cervical intraepithelial neoplasia which means precancerous cells. CIN I and II we watch. It took twenty years of my career for medicine to figure out that most cervical cancer is caused by human papilloma virus and figure out how to type it and then the vaccine. YEAH! Less LEEPS and less cervical cancer.
6. Pick the LEEP wire size. If it is a big lesion, you choose two loops, a small one and a larger one. The goal is to remove all of the cells that are lighting up white.
7. Inject numbing medicine at the four quadrants of the cervix. If they bleed like stink, stop.
8. Give the numbing medicine five minutes to work. Bump the colposcope and have to refocus the evil thing. This will take me about five minutes.
9. Turn on the LEEP machine. Slowly put the loop in the vagina and carefully put it in the cevix (burning) and move from right to left. Or the reverse if you are left handed. A half ball section of cervix will fall out.
10. Place the cervix section in the pathology solution. They will check to be sure that you have clear margins and got it all.
11. Staunch bleeding with the long giant Q tips and Monsel's solution. You are peering in and around the colposcope. Hope that they have not been eating aspirin like candy. Or ginkgo, garlic, coumadin, etc.
12. If it was a large lesion, use the small loop to do a "top hat", another section of cervix further in.
13. Staunch bleeding again. The Monsel's is an iron solution that makes blood coagulate.
14. Wait a bit to be sure.
15. Turn off colposcope and move it. Take out the speculum. Warn patient that she will have "coffee ground" vaginal discharge and don't put anything in there for weeks because it WILL bleed. Be specific: no intercourse. Or tampons. Or anything else.
16. Encourage patient to sit up slowly. How are they? Show them the pathology bottles if they want. Tell them to call if they are soaking a pad an hour with blood. That would mean your office immediately or the ER.
I did not do tons of these and the procedure may have changed. Every one that I did had clear margins. Hooray!
ironed
this was a request