A carbon dioxide (CO2) laser beam is used to:

• Destroy (vaporize) abnormal cervical tissue that can be seen through a magnifying viewing instrument (colposcope).
• Remove abnormal tissue high in the cervical canal that cannot be seen through the colposcope. The CO2 laser can be used to do a cone biopsy (see cone biopsy for abnormal Pap test).

Laser vaporization takes 10 to 15 minutes. The abnormal tissue is destroyed or removed, leaving normal tissue intact.

How it is done

Carbon dioxide laser surgery can be done in your doctor's office, a clinic, or a hospital as an outpatient procedure (you do not have to spend the night in the hospital).

You will need to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an exam table with your feet raised and supported by footrests (stirrups). Your doctor will insert an instrument with curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined.

The procedure is usually done with a numbing medicine injected into the cervix (cervical block). If a cervical block is used, an oral pain medicine may be used along with the local anesthetic.

What To Expect After Surgery

Most women are able to return to normal activity within 2 to 3 days after surgery. Recovery time will depend on how much was done during the procedure.

After laser surgery

• A watery vaginal discharge may occur for about 2 to 3 weeks.
• Pads should be used instead of tampons for 2 to 3 weeks.
• Sexual intercourse should be avoided for 2 to 3 weeks.
• Douching should not be done.

When to call your doctor

Call your doctor for any of these symptoms:

• A fever
• Heavy bleeding (more than you would usually have during a menstrual period)
• Increasing pelvic pain
• Bad-smelling or yellowish vaginal discharge, which may point to an infection

Why It Is Done

Carbon dioxide laser surgery is done when:

• Abnormal cell changes found on a Pap test have been confirmed by colposcopy and cervical biopsy, and the abnormal cells are visible through the colposcope.
• Moderate to severe cell changes are found on a Pap test. If these abnormalities cannot be confirmed by colposcopy, cells may be collected from high up in the cervical canal by cervical biopsy. If the abnormal cells are high in the cervix, the CO2 laser can be used to do a cone biopsy to remove abnormal tissue.

How Well It Works

Carbon dioxide laser surgery is successful in destroying abnormal tissue in about 95% of cases when it is used to vaporize the tissue. When it is used to remove a wedge of abnormal tissue, it is successful in over 93% of cases. ¹

Risks

• A few women may have some cervical bleeding up to 7 to 10 days after laser surgery.
• A few women may have serious bleeding that requires further treatment.
• Infection of the cervix or uterus may develop (rare).
• Narrowing of the cervix (cervical stenosis) that can cause infertility may occur (rare).

What To Think About

Carbon dioxide laser surgery is able to destroy or remove abnormal tissue that is too high in the cervix to be destroyed with cryosurgery.

A carbon dioxide laser can be used to perform a cone biopsy (conization) but is not used as frequently as other conization methods because:

• It requires more specialized training to perform.
• A larger amount of tissue is burned at the margin of the biopsy.
• It is more expensive.

If you have carbon dioxide laser surgery, you need regular follow-up Pap tests. You should have a Pap test in 4 to 6 months or as often as recommended by your doctor. After several Pap test results are normal, you and your doctor can decide how often to schedule future Pap tests.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Citations

1. Addis IB, et al. (2007). Intraepithelial disease of the cervix, vagina, and vulva. In JS Berek, ed., Berek and Novak's Gynecology, 14th ed., pp. 561–596. Philadelphia: Lippincott Williams and Wilkins.