title: Spray Versus Forced Coagulation in Large Loop Excision of the Transformation Zone: A Randomized Trial.
abstract: OBJECTIVE
  Large loop excision of the transformation zone (LLETZ) is the standard surgical treatment for cervical dysplasia. The optimal way to achieve local hemostasis in women undergoing LLETZ is unknown.
  
  
  METHODS
  In a prospective, randomized trial, we compared spray coagulation and forced coagulation in women undergoing LLETZ in a 1:1 ratio. The primary endpoint was time to complete local hemostasis (TCLH). Secondary endpoints were blood loss (Δ hemoglobin before and after LLETZ), pain (numerical visual analog scale, 5-step graphical visual analog scale measured 2-3 hours after LLETZ), and perioperative/postoperative complications (intraoperative need for sutures, postoperative bleeding, infection, and unscheduled readmission). Analysis was by intention to treat.
  
  
  RESULTS
  One hundred fifty-one women were enrolled and were eligible for analysis. Mean (SD) TCLH in 80 women with forced coagulation was 43.3 (38.5) and 28.9 (22.9) seconds in 71 women with spray coagulation (p < 0.001). The secondary endpoints blood loss (Δ hemoglobin, -0.8 [0.8] vs -0.7 [1.1]; p = 0.115), pain (numerical visual analog scale, 4.1 [0.9] vs 4.2 [0.9]; p = 0.283, graphical visual analog scale (1.9 [1.3] vs 1.8 [1.3]; p = 0.888), and perioperative/postoperative complications (6/71 [8%] vs 7/80 [9%]; p = 0.822) were comparable between the 2 arms. In a multivariate analysis, coagulation method (odds ratio = 0.18; 95% CI = 0.09-0.38; p < 0.001) and size of the cervix (odds ratio = 2.43; 95% CI = 1.16-5.15; p = 0.021) were independent predictors of TCLH.
  
  
  CONCLUSIONS
  Spray coagulation is superior to forced coagulation in women undergoing LLETZ and should be used as the standard approach.
authors.affiliation: 1Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany, and the 2Department of Obstetrics and Gynecology, Krankenhaus der Barmherzigen Schwestern, Linz, Austria.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Hilal
authors.forename: Georgia
authors.initials: G
authors.lastname: Mavrommati
authors.forename: Claudia
authors.initials: C
authors.lastname: Foerster
authors.forename: Günther A
authors.initials: GA
authors.lastname: Rezniczek
authors.forename: Lukas A
authors.initials: LA
authors.lastname: Hefler
authors.forename: Clemens B
authors.initials: CB
authors.lastname: Tempfer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D002578:Uterine Cervical Dysplasia / Q000601:surgery*; D055815:Young Adult