***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A r and omized study was performed to compare efficacy and side effects of laser and cryotherapy :  51 patients were treated with laser vaporization and 50 patients with cryotherapy .  Success rates for laser and cryotherapy were not significantly different . Success rates were significantly related to lesion size . Grade of CIN , positive endocervical curettage , parity , and age at treatment were not found to be related . Vaginal discharge , both in duration and amount , was significantly less in patients treated with laser vaporization , compared with cryotherapy , but pain and bleeding occurred more often in patients treated with laser vaporization . A brief review of possible sources of bias in comparative studies on laser and cryotherapy is given , indicating the preference for a r and omized study . It is concluded that widespread introduction of laser facilities in smaller centers is not justified , because the success rates are not better than those of cryotherapy , and because the advantages of less discharge are outweighed by the high cost OBJECTIVE To evaluate the usefulness of bipolar electrocautery scissors for cervical conization . METHODS AND MATERIAL S Forty patients with severe dysplasia/in situ carcinoma of the uterine cervix underwent cervical conization : 20 r and omly selected patients were operated on with the unipolar energy scalpel and the other 20 were operated on with bipolar electrocautery scissors . In both groups operating time , number of ligations , blood loss , duration of recovery , perioperative complications and adequacy of the margins of the lesion were assessed . Data were compared by analysis of variance . RESULTS In the bipolar group the average operating time and duration of recovery were significantly reduced ( halved ) , no ligations were needed and the amount of blood loss was significantly reduced . Regarding perioperative complications , in the bipolar group there were no hemorrhages nor need of a second operation or transfusion . Infections did not occur in either group . We found no difference between the two groups regarding adequacy of the margins of the lesion for a good pathologic examination . CONCLUSION Bipolar electrocautery scissors were safe and useful in cervical conization by reducing the operating time and blood loss without increasing postoperative morbidity Fifty‐five patients were r and omized in a double‐blinded manner to large loop excision of the transformation zone ( LLETZ ) ( 29 patients ) or  radical cervical diathermy with fulgaration ( RCDF ) ( 26 patients ) for treatment of cervical intraepithelial neoplasia ( CIN ) . Patients completed a 2‐month diary of symptoms and completed a 10‐week postoperative question naire . White vaginal discharge lasted 7.3 ( 4.6 ) days ( SD ) for RCDF compared to 3.4 ( 1.6 ) days ( SD ) for LLETZ . There was no significant difference in any other symptoms on analysis This appears to be the first report clearly assessing the length and severity of postoperative symptoms following LLETZ or RCDF . There is no reason on length and severity of postoperative symptoms to choose 1 of these 2 treatment methods over the other Objective To determine whether loop diathermy excision of the transformation zone and laser vaporisation are equally effective in the treatment of cervical intraepithelial neoplasia The results of laser and cryosurgical treatment in 106 patients with histologically proven carcinoma in situ of the uterine cervix ( CIN III ) are presented . Seventy-one patients were treated with the laser  and in 63 of these further follow-up with colposcopy and cytology failed to show any abnormality . This represents an initial success rate of 89 % . In 8 patients ( 11 % ) initial treatment was considered to have failed because of persistent dyskaryotic smears and histological evidence of cervical intraepithelial neoplasia ( CIN II-III ) . Six of these patients were treated successfully with a further laser application and two patients had conization . The overall success rate for the laser was 97 % . Thirty-five patients were treated with  cryosurgery  and subsequent follow-up was negative in 29 of these patients ( 83 % ) . The 6 treatment failures ( 17 % ) were subsequently successfully treated with local destructive therapy ( 4 with cryosurgery , 1 with laser , and 1 with needle diathermy ) . The overall success rate for cryofreezing was 94.2 % . In cases of CIN III the laser is more likely to achieve eradication of the lesion with a single application than cryofreezing In a r and omized trial concerning 123 women with CIN , 59 were treated with laser conization under colposcope without further hemostatic remedy and 64 with cold knife conization guided by Schiller 's iodine dyeing supported by side sutures , vaginal packing and postoperative oral administration of tranexam acid . Follow‐up with colposcopy and cytology was done 3 and 12 weeks post‐conization and then every 6 months . The average follow‐up period was 36 months ( 28–48 ) . Peroperative bleeding was rather less pronounced in the laser group . Postoperatively , however , bleeding requiring treatment was significantly less common in the laser group ( 5 % ) than in the cold knife group ( 17 % ) BACKGROUND Cervical intraepithelial neoplasia ( CIN ) can be managed by ablative or excisional procedures . We have compared the excision time , effectiveness , and safety of loop diathermy ( loop ) against laser conization . METHODS In a prospect i ve study in two hospital departments 222 women were r and omized to loop or laser conization .  Data were collected by question naires after operation and at two follow-up examinations . RESULTS At department A ( 122 women ) , two physicians performed 27 % of the loop and 35 % of the laser excisions ;  at department B ( 100 women ) , the corresponding figures were 69 % and 59 % . Loop was quicker than laser conization in both departments ( median 3 - 4 min versus 10 - 20 min ) , while laser conization was more time consuming in department A ( median A/B = 20/10 min ) . Peroperative bleeding dominated during the laser procedure in both departments and complicated the loop procedure more frequently in department A. Postoperative bleeding occurred with equal frequency in the four groups ( 41.8 % , 52.7 % , 59.2 % , 64.7 % ) . At both departments , bleeding for more than two weeks was reported twice as often after laser conization ( A:13.8 % , B:24.2 % ) , when compared to loop excision ( A:7.1 % , B:13.7 % ) . Residual CIN was found in all of three re-conizations and in one of eight hysterectomy specimens . CONCLUSIONS Loop was quicker than laser excision , per- and postoperative bleeding diminished , and the success rates were comparable . Physicians mastered Loop excision after a few attempts . However , the results improved , when performed by a restricted number of physicians . Histological incomplete excision indicates close colposcopic and cytologic follow-up to identify residual CIN OBJECTIVES Loop electrosurgical excision of the transformation zone ( LEETZ ) was recently associated with relatively high failure rates . We evaluated whether the combination of LEETZ with laser vaporization is superior to LEETZ alone in reducing the rates of recurrent abnormal cytology and residual disease . METHODS The study population included 426 women with histologic diagnosis of cervical intraepithelial neoplasia ( CIN ) 2 - 3 , of whom 289 ( study group ) were treated by  LEETZ followed by laser vaporization of the crater base and walls and 137 ( control group ) were treated by LEETZ alone . All women were followed scrupulously at regular intervals for recurrent abnormal cytology and residual disease . The mean follow-up periods were 43 and 59 months for the study and control groups , respectively . RESULTS Both groups were derived from the same community and were similar in epidemiologic characteristics and disease severity . Although the incidence of positive surgical margins was similar in both groups ( 10.4 and 9.5 % for the study and control groups , respectively ) , recurrent abnormal cytology ( 10.2 % vs 5.5 % , P = 0.07 ) and histologic residual disease ( 21.4 % vs 0 % , P = 0.05 ) were more frequent among women in the control group . This applied to women with both negative and positive surgical margins . Both study and control women with positive surgical margins , especially at the endocervix , were at higher risk for recurrence . CONCLUSION The addition of laser vaporization to LEETZ may improve outcome of both women with positive margins and women with negative margins . Our results support conservative management for all treated women , regardless of cone margin status We compared the pain of  excisional cervical surgery  by the laser or loop diathermy ( LLETZ ) in a r and omised controlled clinical trial . Eighty women with CIN III were recruited from a laser colposcopy clinic specifically adapted to run r and omized trials . They were scheduled for excision of their cervical transformation zone and both groups were matched for age , parity , and size of lesion . We measured linear analogue pain scores , subjective pain scores , and operative time . The laser and loop diathermy inflicts similar discomfort and there is no detectable difference between the median pain scores of women in either group ( P = 0.99 ) . However , in the h and s of an experienced surgeon it takes 4 min extra to excise the cervical transformation zone with a laser compared to loop diathermy . The average time from sitting in the chair to the end of the procedure was 13.02 min ( SD 3.65 ) for the group allocated diathermy surgery compared to 17.30 min ( SD 5.33 ) for a laser excision log transformed t(log transformed data ) = 3.7 ( P < 0.001 ) The objective of this r and omized controlled trial was to determine whether the pure cut setting results in less thermal artefact than the traditional blend setting when performing a large loop excision of the transformation zone ( LLETZ ) . Forty-nine consenting women were r and omized to undergo an LLETZ procedure  using either the pure cut or the blend setting . Two histopathologists , who were blind to the r and omization , examined the specimens and then grade d and measured the degree of thermal artefact . No significant difference was noted at the epithelial margin . At the deep stromal margins , in the blend group , the mean thickness of thermal artefact was 0.382 mm ( 95 % CI , 0.350–0.414 ) and in the cut group 0.325 mm ( 95 % CI , 0.297–0.353 ) . This was statistically significant . No significant difference was detected in terms of grading of thermal artefact , the presence of dysplasia at the specimen margins , or in positive follow-up smears . Although there was less thermal artefact at the deep stromal margin , cautery at this margin does not generally interfere with pathological assessment of the specimen and the pure cut setting does not produce a clinical ly significant decrease in the degree of thermal artefact Ninety patients with cervical intraepithelial neoplasia ( CIN ) were r and omly assigned to loop excision ( n = 38 ) or cold-knife conization ( n = 52 ) . All specimens were well evaluable at histology . The average width of the lesions at histology was 10.2 and 9.7 mm , respectively ( ns ) . The average weight of the specimens was 2.6 and 5.6 g ( P < 0.01 ) and the average depth was 9.2 and 15.8 mm ( P < 0.01 ) , respectively . The distance between the cervical resection margin and CIN was 14 mm after loop excision and 24 mm after cold-knife conization ( P < 0.06 ) . The margins of the specimen were not clear of disease in 8 patients after loop excision and in 12 patients after conization ( ns ) . Two patients after loop excision and in three patients after cold-knife conization had postoperative bleeding . The results suggest that , compared with cold-knife conization , loop excision removes less healthy tissue without reducing the chances for cure In a r and omized study , 204 patients with exocervical intra‐epithelial neoplasia were allocated to either laser evaporation ( 103 ) or cryocoagulation ( 101 ) . The patients were treated on an outpatient basis without anesthesia . In the case of initial treatment failure the same method was to be used for retreatment . One hundred and eighty‐seven patients were followed‐up for an average of 50 months ( 12‐80 ) . Eighty‐six of 94 laser‐evaporated patients ( 91 % ) and 89 of 93 cryocoagulated patients ( 96 % ) were cured after one treatment . Five of 8 laser failures and 3 of 4 cry0 failures were cured by retreatment . The cure rate after one or two laser evaporations was 97 % ( 91 of 94 patients ) , and after one or two cryo coagulations , 99 % ( 92 of 93 patients ) . Eighty per cent of residual or recurrent neoplasia occurred within 15 months and 96 % within 2 years of treatment . No invasive neoplasia occurred during the follow‐up period and no tendency was seen towards higher grade s of intra‐epithelial neoplasia in the failures compared with the initial diagnoses . It is concluded that laser evaporation and cryocoagulation  are equally effective for the treatment of exocervical intra‐epithelial neoplasia The objective of the treatment of cervical intraep 
    Output:
    
No significant differences in treatment failures were demonstrated in terms of persistent disease after treatment .
Large loop excision of the transformation zone appeared to provide the most reliable specimens for histology with the least morbidity .
Morbidity was lower than with laser conisation , although the trials did not provide data for every outcome measure .
There were not enough data to assess the effect on morbidity when compared with laser ablation .
AUTHORS ' CONCLUSIONS The evidence suggests that there is no obvious superior surgical technique for treating cervical intraepithelial neoplasia in terms of treatment failures or operative morbidity