[Laser conization and laser ablation of the transformation zone].

OBJECTIVE

To evaluate postoperative courses and histological results after laser therapy of the transformation zone.

METHODS

From 1993 to 1997, 136 laser interventions were performed (110 conizations and 26 vaporizations); 103 (76%) of these interventions were performed as outpatient procedures and 122 (89%) under local anesthesia.

RESULTS

94 (85%) of the 110 conizations showed tumor-free margins, whereas 12 (11%) had dysplastic changes in one or both margins. Follow-up of these 12 patients revealed 5 normal cytologic controls, 4 cases of hysterectomy without residual disease, 1 case of CIN III in the hysterectomy specimen, 1 case of CIN I in a radical hysterectomy (cervical cancer stage Ib in the histology of the conus), and 1 patient was lost to follow-up. In 4 cases (4%), there was only a suspicion of marginal involvement. These patients had either a normal cytologic control (n = 3) or no residual disease in the hysterectomy specimens (n = 1). There were eight bleedings that had to be treated with bicoagulation.

CONCLUSIONS

Laser therapy offers the possibility of a very precise circumcision at the ectocervical site under colposcopic control. It can mostly be performed as an outpatient procedure under local anesthesia, and the frequency of postoperative complications compares to the other available methods. If the margins show dysplastic changes, follow-up rarely reveals recurrent disease. Expectative management with close cytologic follow-up is, therefore, justified in such cases, if fertility should be maintained.