OBG Management continues to offer concise, timely, and clinically relevant articles; January 2002 is no exception.
I would like to add my pearls to Dr. Marc Toglia’s article, “Cone biopsy: perfecting the procedure” on cold-knife conization.
- Use 4 units of vasopressin and 40 cc of 1% lidocaine (10 cc in each quadrant of the cervical stroma). Vasopressin is less arrhythmogenic than epinephrine.
- Use the Newman endocervical tenaculum to better define the internal os. Place lateral hemostatic sutures at 3 o’clock and 9 o’clock. Avoid sutures postconization, as they will distort the cervix and make follow-up colposcopy more challenging.
- After completing the procedure, open the specimen at 12 o’clock and affix to a paraffin block or tongue blade. This enables a pathologist to “step-section” the specimen, affording more accurate assessment.
Paul Caporossi, MD
Dr. Toglia responds:
I would like to thank Dr. Caporossi for his additional pearls.