Reference Manual - IARC Screening Group

Treatment and FollowupINSTRUMENTS AND EQUIPMENTCryotherapy can be performed in any clinic having the following items:• Examining table• Adequate light source• Bivalve speculum (Cusco or Graves)• Instrument tray or container• Cryotherapy unit• Regular supply of compressed carbon dioxide or nitrous oxide gasThe examining table should allow the examiner to insert the speculumand look at the cervix.Light from a window is usually not sufficient to see the cervix, so use alight source, such as a goosenecked lamp or a flashlight (torch), ifavailable. The light must be strong enough for the examiner to see theupper end of the vagina where the cervix is located. Inspection cannot beperformed if there is not enough light to see the cervix. It is alsoimportant that the light source not be too hot. A lamp that is too hot willbe uncomfortable for both the woman and the provider. A high-qualityflashlight provides adequate light without too much heat. In addition, theflashlight does not require electricity, is portable and can be placed inwhatever position allows for the best view of the cervix.A Graves bivalve speculum is preferred because it has a slightly wideropening (so the cryoprobe can fit through), but both the Graves and theCusco specula can be set and left open while the cervix is beingexamined or treated. This leaves the provider’s hands free to swab thecervix, adjust the light source and manipulate the cervix and speculum inorder to see it fully. A Simms speculum is not recommended.The cryotherapy system 5 (Figure 7-3) enables high-pressurecompressed gas to travel from the gas cylinder into theexpansion/freezing chamber of the cryoprobe. The system consists of thefollowing:• Metal cryotip with plastic sleeve, designed to fit up against the cervixand completely cover the areas surrounding the SCJ and diseased areas;• Hand-held cryotherapy unit (or “cryogun” or “cryoprobe”), whichincludes the handle, freeze and defrost triggers, and insulated probe;• Flexible hose connecting the regulator to the cryotherapy unit; and5In this manual, illustrations and instructions specifically related to the cryotherapy system/unit are based on theWallach LL100 Cryotherapy System. See also Note on page 7-13.7-10 Cervical Cancer Prevention Guidelines for Low-Resource Settings