LLETZ

Te Whatu Ora (Health New Zealand) have an excellent resource on LLETZ treatments available here. 

The Royal College of Obstetricians and Gynaecologists (United Kingdom) also have a good resource available here. 

A LLETZ procedure is performed to remove abnormal cells from the cervix. 

The cervix is unique to the human body as it has an area of cells that transform from one cell type to another. The outer part of the cervix (within the vagina) has skin type (squamous) cells, while the inner part (towards the uterus) has glandular cells. The border between these two cell types is influenced by hormones, and can move throughout the menstrual cycle, with pregnancy, oral contraceptive use and menopause. The "transformation zone" is the area of the cervix where cells can transform from one cell type to another. 

Cells in the transformation zone are susceptible to infection with HPV, a very common virus (80% of the population will get HPV infection at some stage). HPV can cause cells in the transformation zone to undergo changes that cause them to rapidly grow. This abnormal growth (neoplasia) generally starts as low grade changes, called LSIL (Low-grade Squamous Intraepithelial Lesion) or CIN1 (Cervical Intraepithelial Neoplasia). Low grade changes are common and will usually resolve on their own, although about 10% of the time progress to higher grade changes. Higher grade changes, called HSIL (High-grade Squamous Intraepithelial Lesion) or CIN2/3  have a small risk of developing into cervical cancer. (CIN2 has around a 20% chance of progressing to CIN3 within 2 years; CIN3 has around a 1 in 3 chance of progressing into cancer within 10-20 years).  

A LLETZ procedure is a procedure to remove all the cells within the transformation zone of the cervix, including all of the abnormal cells. This is generally around 8mm depth from the front of the cervix, but can vary depending on the shape of the cervix and the cells. 

A LLETZ is usually done with local anaesthetic in a colposcopy room. Sometimes a general anaesthetic is preferred, where you are put to sleep and the procedure is done in an operating theatre. 

A speculum is placed, similar to what is done for a routine colposcopy. The same solutions used at colposcopy are placed on the cervix (acetic acid and iodine). Local anaesthetic is used. This can cause some stinging - a feeling that is similar (usually less discomfort) to the biopsy being taken. The local anaesthetic contains adrenaline to prevent bleeding, which can sometimes cause a feeling of a racing heart.

The LLETZ itself only takes around 30 seconds, and is carried out using a wire loop with electrical current running through. This allows the tissue to be removed as well as minimising bleeding. As this device produces a vapour, a suction device is also required - the procedure is quite noisy with the sounds of the suction, the beeping of the device, and the current. After the LLETZ has been performed, the wire loop is replaced with a similar device to stop any bleeding, which may take another few minutes. The procedure itself should not be painful, but there may be some unusual pressure sensations.

The entire procedure from the time you get onto the colposcopy chair to when you leave the chair should be less than 15 minutes.

After the LLETZ there can be some crampy pain for a few days. It is normal to experience some light vaginal bleeding, and there may be some black or watery discharge that should be very light, but can take 3-4 weeks to completely resolve.

You should avoid anything inside the vagina (intercourse, tampons, menstrual cups) and going underwater (baths, pools, spas) for 4 weeks, and longer if the discharge is not completely settled (showers are fine). 

We will contact you with the results when available, this is usually 2-4 weeks. We expect the results to confirm high grade changes (HSIL) in most cases, and if this is the case, the recommendation is for a cervical smear checking for HPV and abnormal cells, 6 months and 18 months after the procedure. These should be taken by a clinician with a speculum, and can be either with your regular GP or smear taker, or with the gynaecologist. If these are both clear you can return to routine 5 yearly screening. If the laboratory report that the abnormal cells extend to the margins of the tissue that was removed, we will recommend a repeat colposcopy at 6 months rather than a smear.

It is important to note that the LLETZ procedure aims to remove the abnormal cells; it does not treat HPV infection. There is currently no proven treatment for HPV, and it takes on average around a year to clear the infection, but some people may take much longer. If the HPV infection remains after the LLETZ we will recommend ongoing surveillance either with colposcopy or yearly cervical smears depending on your situation and results.