Position: Lithotomy, Prone, Jack-Knife, arms at side on armboards
Time: 5-30 min (very short)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Yes

A very stimulating procedure, so the patient is likely to move if not in a deep enough anesthetic. For this reason, some will use paralytics. However, this is a very quick procedure, so dose the paralytics judiciously and/or make sure a reversal is drawn up and ready.

Positioning – Positioning varies. Lithotomy is common, but the surgeon may prefer prone with a slight-moderate jackknife position.

Prone Position (general considerations): Maintain cervical neutrality. Keep IV’s out of the antecubital space. The patients arms are typically flexed, which will kink the IV. Eye protection should be used as the prone position heightens the risk of corneal abrasion and/or traction on the globe (which can result in blindness). Check the patients eyes/ears/nose regularly throughout the case to ensure they are free of pressure. Positioning of the leads is typically high on the posterior and posterolateral back (somewhere free of pressure and out of surgical borders). Keep your connections and tubing where you’ll have fast access.

This procedure is a first-line treatment for any large ( greater than 1 cm) protruding anogenital wart.

General anesthesia is usually indicated for extensive excision (beyond the superficial dermis) of large, bulky warts.

Carbon dioxide lasers may be used if the surgeon decides laser therapy is necessary.

Reoccurrence is found in approximately one-third of patients that undergo this surgery. Pain can be expected to last one to four weeks.