LLETZ Procedure and Cone Biopsy


Heart care

If your doctor finds precancerous cell changes in your cervical tissue, also known as cervical dysplasia, the area around the tissue may need to be surgically removed to reduce the risk of cancer and the spread of cancer. There are two common ways that this can be done: a cold knife cone biopsy and a Loop Excision of the Transformation Zone (LLETZ Procedure).

Both of these procedures can be used to treat abnormal tissue that your doctor has found during a colposcopy or cervical biopsy, including:

  • Moderate-severe precancerous cell changes
  • Low-grade squamous intraepithelial lesions (LSIL). These are minor cell changes that do not resolve after a few months.


This procedure is typically performed in the hospital. You will be administered a general anaesthetic, which will put you to sleep and keep you from feeling any pain during the procedure. With you on your back, the surgeon will insert a speculum into your vagina to access the cervix. Then, the surgeon will use a surgical knife to remove a small, cone-shaped sample of tissue from the cervix. The sample can be evaluated in the lab for signs of cancer. The aim of the surgery is to remove abnormal tissue before the dysplasia becomes cancerous.

A LLETZ can usually be performed at London Obs & Gynae Clinic,, however, sometimes it may be performed at a hospital. During the procedure, you will lie on your back with your feet in stirrups. Using a speculum, your doctor will open your vagina to gain access to your cervix, much like during a regular pelvic screen. The doctor will then inject a numbing agent into your cervix. This is known as a cervical block, and it can also be used in combination with oral or intravenous pain medication. Additionally, we often use Nitrous Oxide (aka “laughing gas”) while performing this procedure to greatly minimise pain as well as anxiety.

The LLETZ instrument is an electrified wire loop at the end of a narrow wand. The loop can easily pass through your cervical tissue to remove a small sample, which can be tested for cancer. The goal of the procedure is to remove the abnormal cells to decrease the chances of cancer.

LLETZ is an effective and precise surgery that will only remove a small amount of healthy tissue along with the abnormal cells. It is often less costly than a biopsy or laser treatment and usually requires no hospital stay.

When a sample of abnormal cervical tissue is removed via LEEP or cold knife cone biopsy, it is sent to the lab for testing. Within a few days, your doctor can tell you the results. If your results were abnormal, that means that there are areas of cancerous or precancerous cell changes in your cervix. This is often detected in a colposcopy/cervical biopsy done prior to the procedure. Precancerous cervical cells are known as Cervical Intraepithelial Neoplasia (CIN) and there are three grades of severity.

  • CIN I – Mild dysplasia
  • CIN II – Moderate dysplasia
  • CIN III – Severe dysplasia or carcinoma

Risks of LLETZ Procedure and Cold Knife Cone Biopsy

As far as surgical procedures go, these techniques are quite safe. There are, however, some risks involved that you should discuss with your doctor, including:

  • Cervical stenosis : This is a complication in which the cervix narrows, making it more difficult to become pregnant naturally
  • Premature birth : Studies have shown that LLETZ and Cold Knife Cone Biopsy can lead to a syndrome known as incompetent cervix, which may result in a premature delivery if you become pregnant
  • Cervical scarring : Adhesions on the cervix may cause pain during your period, fertility problems, and delivery problems
  • Tissue damage : including damage to the bladder or bowel
  • Haemorrhaging
  • Infection

Neither procedure requires an overnight hospital stay. You may experience some unpleasant symptoms after your surgery, including:

  • Mild cramping. You can take ibuprofen or use a heated pad to manage the pain
  • Vaginal discharge for 1-3 weeks
  • Discharge that is dark or brown in colour

Avoid putting anything into your vagina for the first 3-4 weeks. Abstain from sexual intercourse and use pads instead of tampons to absorb blood. Douching is not recommended.
Complications are rare, but you will want to call your doctor if you’re experiencing worsening symptoms or any signs of infections, such as:

  • Fever, nausea
  • Foul-smelling discharge
  • Worsening pain
  • Severe bleeding or clotting – going through at least one pad each hour

About 3-4 months after your procedure, schedule a follow-up appointment with your doctor. Your gynaecologist may perform another pap smear to monitor the cells of your cervix.


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