49327 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List sepa

Name of the Procedure:

Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple.

Summary

This procedure uses a minimally invasive technique known as laparoscopy to place small devices, such as fiducial markers or dosimeters, inside the abdominal or pelvic cavities. These devices help guide radiation therapy by marking specific locations and measuring radiation doses.

Purpose

The purpose of this procedure is to accurately guide radiation therapy for conditions such as cancer within the abdomen or pelvis. The placement of these devices ensures that radiation is delivered precisely to the targeted areas, improving treatment efficacy and minimizing damage to surrounding healthy tissue.

Indications

• Cancerous tumors within the abdomen, pelvis, or retroperitoneum.
• Need for precise radiation targeting.
• Patients who require radiation therapy as part of their cancer treatment plan.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments could be necessary, particularly for those on blood thinners.
• Pre-procedure imaging tests, like CT or MRI scans, may be performed to plan the procedure.
• A thorough medical evaluation to assess fitness for surgery.

Procedure Description

1. The patient is placed under anesthesia to ensure they are asleep and pain-free.
2. A small incision is made in the abdomen to insert a laparoscope (a thin tube with a camera).
3. Additional small incisions may be made to insert surgical instruments.
4. The targeted area within the abdomen, pelvis, or retroperitoneum is located.
5. Devices, such as fiducial markers or dosimeters, are precisely placed to ensure accurate radiation delivery.
6. Imaging guidance, like ultrasound or CT scans, may be used to confirm device placement.
7. The surgical instruments are removed, and the incisions are closed with sutures or staples.

Duration

The procedure typically takes between 1 to 3 hours, depending on the complexity and number of devices being placed.

Setting

This procedure is usually performed in a hospital's operating room or a specialized surgical center.

Personnel

• Surgeons specialized in laparoscopic procedures.
• Anesthesiologists to manage anesthesia.
• Nursing staff to assist during the surgery and provide post-operative care.
• Radiologists or oncology specialists for imaging guidance.

Risks and Complications

• Common risks include infection, bleeding, and pain at the incision sites.
• Rare risks include injury to nearby organs, complications from anesthesia, and issues related to the placement of the devices.
• Management of complications involves antibiotics for infections, pain management, and possible additional surgery if a serious complication arises.

Benefits

• Enhanced accuracy of radiation therapy, potentially increasing treatment efficacy.
• Reduced risk of damage to surrounding healthy tissues.
• Minimally invasive approach leads to shorter recovery times and less post-operative pain.

Recovery

• Patients can usually go home the same day or after a short hospital stay.
• Post-procedure care includes wound care, pain management, and activity restrictions.
• Most patients can resume normal activities within 1 to 2 weeks.
• Follow-up appointments are necessary to monitor recovery and the effectiveness of the radiation therapy.

Alternatives

• Traditional open surgery for device placement, which is more invasive.
• Non-invasive imaging techniques alone, although they might not provide the same precision for radiation therapy.
• Pros and cons should be discussed with a healthcare provider to determine the best approach for individual cases.

Patient Experience

• Patients may experience some discomfort and mild pain at the incision sites.
• Pain is typically managed with medication.
• It's normal to feel some fatigue and soreness in the days following the procedure.
• Detailed instructions will be provided to ensure a smooth recovery and address any concerns.