b. Operative Procedure (see figure 2-7).
(1) Anterior and posterior vaginal retractors are placed, and the cervix is
pulled down with smooth ovum or sponge forceps. With thumb forceps and dissecting
scissors, the mucosa over the anterior cervix is opened to permit the bladder to be
(2) The cervix is lifted, and the posterior vaginal mucosa is similarly incised
at the level of the peritoneal reflection. With ligature carriers, the lateral mucosa is
tunneled on either side.
(3) The prepared ligature is placed at the desired level and anchored
posteriorly with silk suture, then drawn tight in front to close the cervix. The suture is
(4) The collar ligature is anchored with silk sutures anteriorly. The anterior
and posterior mucosal incisions are closed with chromic sutures number 0 or number
2-0 to complete the procedure.
2-27. CONIZATION AND BIOPSY OF THE CERVIX
(1) This procedure is the removal of diseased cervical tissue to treat
strictures of the cervix and chronic cervicitis. The conization may be performed either
by scalpel resection and suturing or by the application of cutting electrosurgical current
with an active electrode inserted into the cervical canal.
(2) Endometrial biopsy is done to determine the menstrual phase and carry
out histological study of the endometrium. Scalpel conizations are done for diagnostic
purposes, such as when the patient has a positive Papanicolaou (Pap) smear.
Conization of the cervix may be done in some cases in which hysterectomy is indicated
and in which benign disease of the cervix is present. It may also be done in those
cases in which total hysterectomy is not feasible.
b. Operative Procedure.
(1) The posterior vaginal wall is retracted by a speculum and the anterior
vaginal wall by lateral retractors. The outer portions of the cervix are grasped with a
tenaculum, and the cervix is drawn toward the introitus; then the anterior speculum is
removed. Cystic cervix may be treated with a needle electrode. Endometrial biopsy
may be done. Bleeding points may be coagulated.
(2) For cauterization, the electrode is passed into the cervical canal, and the
diseased membrane is removed. In patients with a positive Pap smear, the cervical
cone is excised with a scalpel and bleeding controlled by coagulation and pressure.