Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy
CPT4 code
Name of the Procedure:
Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy
Common name(s): Minimally invasive pelvic lymph node removal
Summary
Laparoscopy with bilateral total pelvic lymphadenectomy is a minimally invasive surgical procedure used to remove lymph nodes from both sides of the pelvis. It is performed using small incisions and a laparoscope—a thin tube with a camera and light—allowing the surgeon to see inside the pelvic cavity and remove the lymph nodes without making large incisions.
Purpose
This procedure addresses conditions such as certain cancers (e.g., gynecological, bladder, or prostate cancer) where there is a need to check or remove lymph nodes to prevent the spread of cancer. The goal is to thoroughly remove lymph nodes that may contain cancer cells, helping to stage the cancer and guide further treatment.
Indications
- Diagnosis or staging of pelvic cancers
- Suspected or confirmed spread of cancer to pelvic lymph nodes
- High risk of lymph node metastasis in pelvic malignancies
Preparation
- Patient may need to fast for 8-12 hours prior to the surgery.
- Certain medications, especially blood thinners, may need to be adjusted or stopped.
- Pre-operative blood tests, imaging studies, and possibly a bowel preparation regimen might be required.
Procedure Description
- The patient is placed under general anesthesia.
- Several small incisions are made in the abdomen.
- A laparoscope is inserted through one of the incisions, providing a visual guide for the surgeon.
- Additional instruments are inserted through other incisions to carefully dissect and remove the lymph nodes.
- The lymph nodes are then sent to a lab for pathological examination.
- The incisions are closed with sutures or surgical glue.
Duration
The procedure typically takes between 1.5 to 4 hours, depending on the extent of lymph node removal required.
Setting
The procedure is typically performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeon (often a specialist in urology, gynecology, or oncology)
- Surgical nurses or assistants
- Anesthesiologist
- Operating room staff
Risks and Complications
- Infection at the incision sites
- Bleeding or hematoma
- Injury to surrounding organs or blood vessels
- Nerve damage
- Blood clots
- Lymphedema (swelling due to lymph fluid build-up)
Benefits
- Minimally invasive with smaller incisions and quicker recovery.
- Accurate staging and possible reduction in cancer spread.
- Improved surgical precision with the use of laparoscopy.
Recovery
- Pain management with medications as prescribed.
- Most patients can return to normal activities within 2-4 weeks.
- Follow-up appointments to monitor recovery and discuss lab results.
- Restrictions on heavy lifting and strenuous activities for several weeks.
Alternatives
- Open pelvic lymphadenectomy (more invasive with larger incision).
- Chemotherapy or radiotherapy (depending on the cancer type and spread).
- Active surveillance in certain low-risk cases.
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel pain. Post-operatively, patients may experience some pain and discomfort at the incision sites, which can be managed with pain medications. Expect some limited mobility and mild swelling. Most patients can return to normal activities within a few weeks, with adherence to post-operative care instructions.