Thermal Ablation / Leep

1. Thermal Ablation

Thermal ablation is a procedure used to treat abnormal cells on the cervix by destroying them with heat. It is a less invasive technique compared to other methods like a hysterectomy or conization.

How it Works:

• A probe is inserted into the cervix through the vagina.
• The probe delivers heat (often using a heated balloon or electrical current) to the affected tissue.
• The heat destroys the abnormal cells, causing them to slough off and be replaced by healthy tissue.

Indications:

• Thermal ablation is typically used for low-grade cervical dysplasia (CIN 1) or for women who have tested positive for HPV but have not developed more severe precancerous changes.
• It is a treatment option for women who do not wish to have children in the future, as it does not involve cutting tissue from the cervix.

Advantages:

• Non-invasive (no incisions required).
• Relatively quick and low risk.
• Short recovery time compared to surgical options.

Disadvantages:

• Not suitable for all types of abnormal cells (e.g., higher-grade dysplasia or cancer).
• May require follow-up procedures, as there is a chance that abnormal cells could return.
• May be less effective for large areas of abnormal tissue.

2. LEEP (Loop Electrosurgical Excision Procedure)

LEEP is a procedure in which abnormal cells are removed from the cervix using a thin wire loop that carries an electric current. The wire loop is used to cut away the tissue or abnormal areas from the cervix.

How it Works:

• A thin wire loop is inserted through the cervix.
• The loop is heated by an electrical current and used to excise the abnormal tissue.
• The procedure is typically performed under local anesthesia.

Indications:

• LEEP is typically used for moderate to severe dysplasia (CIN 2 or CIN 3) or in cases where cervical cancer is suspected.
• It is often performed when a Pap smear or biopsy shows abnormal cells that need to be removed for diagnostic or treatment purposes.

Advantages:

• Provides a tissue sample, which can be sent to pathology for further examination (important for diagnosing the severity of abnormalities).
• Effective for removing precancerous tissue, with a high cure rate for CIN.
• Minimal recovery time (compared to surgical removal of the cervix).
• Preserves the cervix, which is important for fertility.

Disadvantages:

• Risk of complications, such as bleeding or infection.
• There is a small risk of cervical stenosis (narrowing of the cervix) or premature labor if too much tissue is removed.
• Not suitable for very large areas of abnormal tissue.
• It can be less effective if the abnormal tissue is too deep in the cervix.

Key Differences Between Thermal Ablation and LEEP:

• Technique: Thermal ablation uses heat to destroy abnormal tissue, while LEEP uses an electrical current to excise (cut) tissue.
• Indications: LEEP is more commonly used for moderate to severe dysplasia, whereas thermal ablation is generally used for low-grade abnormalities.
• Tissue Removal: LEEP physically removes tissue, which can be sent for further pathological testing, while thermal ablation destroys tissue but doesn’t provide a sample for biopsy.
• Recovery: Both procedures are relatively quick with minimal recovery time, but LEEP carries a slightly higher risk of complications like infection or excessive bleeding.

Aftercare and Considerations:

Both procedures require some aftercare:

• Bleeding: Some bleeding or spotting may occur after the procedure. It’s important to avoid sexual intercourse, tampon use, and douching for a few weeks to reduce the risk of infection.
• Follow-up: Regular follow-up exams are necessary to ensure that abnormal cells do not return. Your doctor will schedule a follow-up Pap smear or HPV test.
• Pregnancy Considerations: If you are planning to become pregnant, discuss this with your doctor. While these procedures do not typically affect fertility, the risk of preterm labor or cervical incompetence (weakening of the cervix) may increase if too much tissue is removed.

In Summary:

• Thermal Ablation is a heat-based treatment for low-grade cervical abnormalities.
• LEEP is an electrical excision technique that is often used for moderate to severe abnormalities and allows for diagnostic tissue removal.

Both procedures are highly effective in treating precancerous cervical changes and are typically chosen based on the severity of the condition, the patient’s fertility goals, and other individual factors. Always consult with your healthcare provider to determine the best treatment option for your specific needs.