Loop Electrode Excision Procedures: Terminology
Loop electrode excision procedures are referred to by all of the following terms: LETZ, LEEP, and cervical loop diathermy. These terms are used interchangeably in clinical practice to describe the same electrosurgical technique for cervical tissue excision.
Terminology Explained
Loop electrosurgical excision procedures have several synonymous names in medical literature and clinical practice:
- LEEP (Loop Electrosurgical Excision Procedure): The most commonly used term in the United States 1
- LETZ (Loop Excision of the Transformation Zone) or LLETZ (Large Loop Excision of the Transformation Zone): Terms more commonly used in European countries 2, 3
- Cervical loop diathermy: Another term referring to the same procedure 3
Technical Description
The procedure involves:
- Using a thin wire loop electrode with high-frequency electrical current
- Excising the transformation zone of the cervix in one piece when possible
- Allowing for histological examination of the excised tissue 1, 3
Clinical Applications
Loop electrode excision is primarily used for:
- Diagnostic excision of suspicious cervical lesions
- Treatment of cervical intraepithelial neoplasia (CIN)
- Obtaining tissue specimens for pathological examination 1
Advantages Over Other Methods
- Provides tissue for histopathological examination (unlike ablative methods)
- Can be performed in an outpatient setting
- Usually requires only local anesthesia
- Has lower blood loss compared to cold-knife conization
- Allows for shorter operative times 1, 4
Variations
Some specialized variations of the technique include:
- C-LETZ (Contoured Loop Excision of the Transformation Zone): A modification designed to produce one-piece specimens with clearer margins 5
Important Considerations
- The NCCN Guidelines recommend cold knife conization as the preferred approach for diagnostic excision, though LEEP is acceptable if adequate margins and proper orientation can be obtained 1
- When performed properly, loop excision procedures have success rates comparable to other treatment modalities for CIN 1
Loop electrode excision procedures represent an important technique in gynecologic practice that bridges diagnostic and therapeutic capabilities in a single procedure, regardless of which term (LEEP, LETZ, or cervical loop diathermy) is used to describe it.