1. Preparation: Place the patient in the lithotomy position, place a grounding pad on the patient’s thigh, and connect the pad to the LEEP base unit. Connect the LEEP handle to the base unit, and insert the desired loop wire into the end of the LEEP handle (Figure 30-2). Insert an insulated vaginal speculum, and clearly visualize the cervix. Connect the smoke evacuation hose to the speculum to ensure clear visibility during the procedure.

2. Anesthesia: Apply 5% acetic acid to the cervix. Identify the margins of the dysplastic tissue to be removed. Lidocaine with epinephrine is injected in 1-cc amounts circumferentially around the planned excision area to provide a complete field block of the area to be excised. These injections should be done at 12 o’clock, 2 o’clock, 4 o’clock, 6 o’clock, 8 o’clock, and 10 o’clock positions. Starting with the lower injections (at 4 o’clock, 6 o’clock, and 8 o’clock positions) and injecting slightly larger volumes will tilt the cervix into a more favorable aspect for the rest of the procedure. Inject 1 cc of anesthetic at 6 o’clock and 12 o’clock positions just at the opening of the os, a full cm deep angled away from the os, if a top-hat excision is planned (Figure 30-3).