Controversies in the Choice of the Optimal Therapeutic Approach to High Grade Intraepithelial Lesions (HSIL) of the Cervix

The incidence of preinvasive changes in the cervix is constantly rising. It is particularly alarming that there is a larger number of younger patients in whom some stage of these changes has been diagnosed or who had already received some type of treatment before. Technological development and improvement of various forms of treatment have lead to changes in the surgical approach to intraepithelial lesions of the cervix. The techniques that have been developed for this purpose, besides the cold-knife conization, include loop excision, radio wave conization, laser conization and, recently, the conization by Harmonic scalpel. The question that inevitably arises is: Has the technological development led to more conservative approaches and improvement in the results of surgical treatment? This paper will try to partly answer this question and initiate some new questions and dilemmas. A comparative review of all of the abovementioned surgical techniques and their detailed analysis is expected to provide at least some answers to the controversial opinions for and against the new surgical procedures. The results of surgical treatments and their complications were analyzed with particular emphasis on the influence that these methods have on fertility. The conclusion is that there is no ideal surgical procedure which could replace and neglect the experience of a colposcopist. New surgical techniques have brought more surgical comfort and faster recovery but have not demonstrated significant change in the final results of treatment and recurrence.