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clinical outcome (clearance of disease) is assessed at follow-up cytology/HPV testing, typically around 6 months."},"fly_home_after_days":{"min":2,"max":5,"unit":"days","qualifier":"After same-day discharge; delayed bleeding can occur at days 7–14, so earlier flights depend on surgeon clearance."},"follow_up_visits":[{"purpose":"result_review","requirement":"routine","after":{"min":14,"max":28,"unit":"days","qualifier":"Histology review including margin status, counted from the procedure."}},{"purpose":"assessment","requirement":"routine","after":{"min":150,"max":210,"unit":"days","qualifier":"Test-of-cure cytology/HPV testing, commonly about 6 months after the procedure."}},{"purpose":"wound_check","requirement":"conditional","after":{"min":7,"max":28,"unit":"days","qualifier":"Only if heavy bleeding, fever, foul discharge or persistent pain."}}],"indications":["High-grade cervical intraepithelial neoplasia (CIN 2–3) or adenocarcinoma in situ","Persistent CIN/abnormal cytology with inadequate or discordant colposcopy/biopsy","Suspected microinvasive disease needing diagnostic excision","Endocervical lesion not fully visible at colposcopy"],"main_risks":["Bleeding during or after procedure (delayed at 1–2 weeks)","Infection","Cervical stenosis","Cervical insufficiency; higher preterm birth risk, especially with larger excisions","Anesthesia-related risks","Rarely, injury to adjacent organs"],"pain":"Mild to moderate cramping and lower abdominal discomfort for a few days, usually managed with simple analgesics.","preparation":["Pre-operative colposcopy and biopsy confirmation","Pregnancy test and scheduling away from menstruation","Pre-anesthesia assessment and fasting as instructed","Review of bleeding risk and medications with the surgeon","Treat active genital infection beforehand"],"recovery_timeline":[{"phase":"First 24–48 hours","description":"Cramping and light bleeding or discharge; rest advised.","restrictions":["No tampons or intercourse","Avoid heavy lifting"]},{"phase":"Days 3–14","description":"Brown or blood-stained discharge that gradually decreases; a bleed may occur as the scab separates around days 7–14.","restrictions":["No tampons, douching, baths or swimming","Avoid sexual intercourse"]},{"phase":"Weeks 2–4","description":"Discharge settles; return to normal activity and exercise.","restrictions":["Avoid intercourse until about 4 weeks or as advised"]},{"phase":"Weeks 4–8","description":"Cervix largely healed; follow-up cytology/HPV plan confirmed.","restrictions":[]}],"rehabilitation_days":{"min":7,"max":14,"unit":"days","qualifier":"Ordinary functional recovery to normal daily activity; cervical healing continues for several weeks."},"result_longevity":"Excision clears the lesion in roughly 90% of cases, but recurrence risk persists, so follow-up cytology/HPV testing is advised, depending on margin status and HPV persistence.","revision_rate_pct":{"min":5,"max":15,"unit":"percent","qualifier":"Repeat excision or further treatment for positive margins or residual/recurrent disease within 2 years."},"scars":"No external scar; the cervix heals with an internal scar that may slightly alter cervical shape or narrow the canal.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"Single operative session."},"stages":[{"code":"conization","label":"Cone excision of the cervical transformation zone (cold-knife, laser or LEEP/LLETZ)","after":{"min":0,"max":0,"unit":"days","qualifier":"Performed at the initial session."}}],"qualifier":"One-stage procedure; follow-up checks are not treatment sessions."},"success":{"metric":"Disease-free after excision (no residual or recurrent CIN)","value":90,"unit":"percent","horizon":"24 months","population":"Women with CIN 2–3 treated by conization","evidence_status":"proven"},"techniques":[{"name":"LEEP/LLETZ (loop electrosurgical excision)","suits_whom":"Most women with CIN 2–3 with ectocervical lesions of suitable size.","recovery":"Typically quick, with discharge for 2–4 weeks."},{"name":"Cold-knife conization (scalpel)","suits_whom":"Suspected microinvasion, glandular lesions or when an intact specimen without thermal artifact is needed.","recovery":"Often slightly longer, with somewhat higher bleeding risk."},{"name":"Laser conization","suits_whom":"Selected cases where precise excision is preferred and equipment is available.","recovery":"Similar to cold-knife conization."}],"treatment_conditions":["day_case"],"treatment_duration_hours":{"min":0.25,"max":0.75,"unit":"hours","qualifier":"Operative time for one conization; excludes anesthesia preparation and recovery."},"initial_assessment_documents":["Cervical biopsy histology report","Colposcopy report","Recent Pap smear (cytology) report","HPV test result","Colposcopy images (if available)","Gynecologist referral letter or summary"],"travel_trips":{"min":1,"max":1,"one_trip_possible":true,"qualifier":"Single-stage procedure; stay 2-5 days. Histology review can be remote; test-of-cure at about 6 months is done at home."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Confirm the surgeon is trained and experienced in the exact procedure you are considering, not just in surgery generally","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Verify that the surgeon is trained and experienced in performing the procedure you are considering.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C2","text":"Ask for certification information and the name of the body that certified the surgical setting","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Ask for certification information and the name of the certifying body when assessing a surgical setting.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C3","text":"Check that the surgeon who consults with you is the same person who will carry out the procedure","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Check that the surgeon you consult with, will be the same person carrying out the procedure.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C4","text":"Ask whether a doctor is always present in the clinic and whether a high dependency or intensive care unit exists","scope":"treatment_abroad","source":{"url":"https://www.bapras.org.uk/public/patient-information/cosmetic-surgery/cosmetic-surgery-abroad","host":"bapras.org.uk","quote":"Is there always a doctor in the clinic and is there a high dependency or intensive care unit?","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C5","text":"Ask whether the surgeon and the facility use a surgical safety checklist, which can reduce complications","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Do the surgeon and his/her facility use a safety checklist?","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"An advert or information that guarantees complete success should raise concerns","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Any advert or information that guarantees complete success should raise concerns.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F2","text":"Forceful persuasion or cheap, time-limited offers pushing you into a quick decision","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Don’t be pressured into quick decisions either through forceful persuasion or cheap, time limited offers.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F3","text":"A price that sounds too good to be true probably is","scope":"treatment_abroad","source":{"url":"https://www.plasticsurgery.org/news/articles/will-economic-uncertainty-drive-more-patients-overseas-for-plastic-surgery-what-to-consider-and-how-to-stretch-your-dollar-back-home","host":"plasticsurgery.org","quote":"If the price sounds too good to be true, it probably is.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Bleeding heavier than a normal period","urgency":"contact_clinic","general":false,"source":{"url":"https://ashfordstpeters.nhs.uk/leaflets/3688-gynaecology-leaflet-colposcopy-and-lletz-biopsy","host":"ashfordstpeters.nhs.uk","quote":"Bleeding heavier than a normal period.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W2","text":"Discharge with a strong or unpleasant smell","urgency":"contact_clinic","general":false,"source":{"url":"https://ashfordstpeters.nhs.uk/leaflets/3688-gynaecology-leaflet-colposcopy-and-lletz-biopsy","host":"ashfordstpeters.nhs.uk","quote":"Discharge with a strong or unpleasant smell.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W3","text":"Very heavy bleeding with clots","urgency":"emergency","general":false,"source":{"url":"https://www.wwl.nhs.uk/pdfreader/cnv-wwl-68ca8bcc8e01d1.75236655","host":"wwl.nhs.uk","quote":"If the bleeding is very heavy and you start to pass clots, or you have an offensive smelling discharge, please ring the ward for advice on one of the numbers at the end of this leaflet.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W4","text":"High temperature (fever)","urgency":"contact_clinic","general":true,"source":{"url":"https://ashfordstpeters.nhs.uk/leaflets/3688-gynaecology-leaflet-colposcopy-and-lletz-biopsy","host":"ashfordstpeters.nhs.uk","quote":"A high temperature (fever).","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"take_home":{"status":"ok","items":[{"id":"T1","text":"Ask for written details of the procedure before you leave the hospital","document":"written procedure 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cervix","name":"Hysterectomy","source":{"url":"https://www.wwl.nhs.uk/pdfreader/cnv-wwl-68ca8bcc8e01d1.75236655","host":"wwl.nhs.uk","quote":"Hysterectomy – removing the womb and the neck of the womb (in operating theatre) under general anaesthetic.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200},"operation_id":null}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"technique_details":{"status":"ok","items":[{"id":"leep","name":"LEEP/LLETZ (loop electrosurgical excision)","how_it_works":{"text":"A heated wire loop removes abnormal cervical tissue","source":{"url":"https://www.wwl.nhs.uk/pdfreader/cnv-wwl-68ca8bcc8e01d1.75236655","host":"wwl.nhs.uk","quote":"LLETZ (Large Loop Excision of Transformation Zone) – removing abnormal area of the neck of the womb with heated loop of wire, under local anaesthetic or general anaesthetic.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},"recovery_daily":{"status":"missing","reason":"no_official_source"}},{"id":"cold-knife-conization","name":"Cold-knife conization (scalpel)","how_it_works":{"text":"Uses a surgical knife to remove cervical tissue","source":{"url":"https://my.clevelandclinic.org/health/procedures/23381-cone-biopsy","host":"my.clevelandclinic.org","quote":"Cold-knife conization uses a surgical knife (scalpel).","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},"recovery_daily":{"event":"back_to_daily_activities","min":1,"max":1,"unit":"weeks","label":"1 week","source":{"url":"https://my.clevelandclinic.org/health/procedures/23381-cone-biopsy","host":"my.clevelandclinic.org","quote":"Most people can return to their daily activities in about one week.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}}},{"id":"laser-conization","name":"Laser conization","how_it_works":{"text":"A laser 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