Monsel's solution is also applied to the bed and may reduce late bleeding. The cervix is anesthetized as above except that if intracervical anesthesia is used, an additional 0.5 to 2cc of Lidocaine is infiltrated at 6 and 12 o'clock around the os to a depth of approximately 1 cm. The external os and distal endocervical canal can be excised to 9 to 10 mm, usually with a 10 mm x 10 mm loop or square electrode. Orientation of the specimen is unnecessary since the deep os margin will be lined with columnar epithelium and the shallow margin with squamious epithelium. The rest of the transformation zone then can be excised in the usual manner.
Some physicians advocate removing the external transformation zone first and then excising the os.
When using this method, the orientation of the central os cut must be carefully marked or the pathologist will be unable to tell which end is from the deep margin and whether or not the deep margin is involved with dysplasia. With either method, the end result is similar to a cold knife conization performed in the operating room. Patient instructions should include prohibition of sexual intercourse, douching, and tampon use for two to four weeks. A discharge is expected for two to three weeks, but may last up to six weeks. The patient should report any significant bleeding or malodorous vaginal discharge.