Impact of Intraoperative Ultrasound-Guided Loop Electrosurgical Excision Procedure With Individualized Marking on Perioperative Stress Responses, Immune Parameters, and Clinical Outcomes: A Comparative Study With Conventional Surgery

Abstract

AIM: This study compared the standard loop electrosurgical excision procedure (LEEP) with an enhanced technique incorporating intraoperative ultrasound guidance and individualized marking for high-risk human papillomavirus (HPV)-associated cervical lesions. The primary focus was on their differential impact on stress injuries incurred during the perioperative period. Furthermore, secondary outcomes included surgical precision, modulation of local immune microenvironment, and clinical endpoints, such as complications, HPV clearance, and recurrence. METHODS: This retrospective cohort study included high-risk HPV-induced cervical intraepithelial neoplasia (CIN) II–III patients (n = 122) who were treated between January 2022 and March 2024. Patients were divided into two groups: an observation group (n = 58), which received intraoperative ultrasound-guided LEEP with individualized marking, and a control group (n = 64), which received conventional LEEP. The outcome measures evaluated were (1) perioperative stress hormones and inflammatory markers, (2) surgical parameters (intraoperative blood loss, margin positivity, and cervical canal adhesion rates), (3) postoperative complications (infection, bleeding, and cervical canal stenosis), and (4) HPV clearance and recurrence rates. RESULTS: Postoperative stress and the levels of inflammatory markers were significantly reduced in the observation group compared to the conventional group (p < 0.05). However, the observation group demonstrated significant improvement, including reduced intraoperative bleeding, fewer positive margins, and increased HPV clearance rates (p < 0.05). Regarding postoperative complications, the observation group exhibited a significant reduction in acute infection and Cervical canal adhesion rates compared with the control group (p < 0.05). Finally, postoperative Visual Analogue Scale (VAS) and Hospital Anxiety and Depression Scale-anxiety (HADS-A) scores were lower in the observation group than in the control group (p < 0.05). CONCLUSIONS: The use of intraoperative ultrasound-guided LEEP with individualized marking is associated with attenuated perioperative stress responses and a more preserved immune microenvironment. This, in turn, improves HPV clearance rates and diminishes postoperative complication risks.

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