58548 Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed

Name of the Procedure:

Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed

Summary

Laparoscopy with radical hysterectomy is a minimally invasive surgical procedure that involves the removal of the uterus, surrounding tissues, lymph nodes, and possibly the fallopian tubes and ovaries. The surgery is performed using small incisions and a camera to guide the surgeon.

Purpose

This procedure is typically conducted to treat gynecologic cancers, such as cervical or endometrial cancer. The goals of the surgery include removing the cancerous tissues, reducing the spread of cancer, and sampling lymph nodes to check for metastasis.

Indications

• Diagnosed cervical or endometrial cancer
• Suspicion of metastasis to pelvic or para-aortic lymph nodes
• Large, recurrent, or aggressive gynecologic tumors
• Patients who require removal of reproductive organs due to malignancy

Preparation

• Fasting for a specific period before the procedure (usually from midnight the night before)
• Blood tests, imaging studies, and possibly an EKG to assess overall health
• Discontinuation of certain medications as instructed by the healthcare provider
• Pre-operative physical examination and consultation with the surgical team

Procedure Description

1. General anesthesia is administered.
2. Several small incisions are made in the abdomen.
3. A laparoscope (a camera) is inserted through one of the incisions to provide a visual guide.
4. Surgical instruments are inserted through other incisions.
5. The uterus, surrounding tissues, pelvic lymph nodes, and in some cases, the fallopian tubes and ovaries are carefully removed.
6. Optional: Sampling of para-aortic lymph nodes for biopsy.
7. The incisions are closed with sutures or staples.

Tools and Equipment:

• Laparoscope
• Specialized laparoscopic surgical instruments
• General anesthesia equipment

Duration

The procedure typically lasts between 3 to 5 hours.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Gynecologic oncologist or surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists
• Pathologist (for lymph node sampling/biopsy analysis)

Risks and Complications

• Bleeding and infection
• Injury to surrounding organs (bladder, bowel, ureters)
• Blood clots
• Anesthesia-related complications
• Lymphedema (swelling due to lymph node removal)
• Complications requiring additional surgery

Benefits

• Effective removal of cancerous tissues
• Accurate staging and assessment of cancer spread
• Potentially improved survival and quality of life
• Smaller incisions leading to reduced pain and faster recovery compared to open surgery

Recovery

• Hospital stay of 2 to 3 days post-procedure
• Pain management with prescribed medications
• Limited physical activity for 4 to 6 weeks
• Follow-up appointments for monitoring recovery and reviewing biopsy results
• Possible restrictions on lifting and strenuous activities

Alternatives

• Open (abdominal) radical hysterectomy
• Radiotherapy
• Chemotherapy
• Combination therapies (chemoradiation)
• Less extensive surgical options for early-stage cancer

Pros and Cons of Alternatives:

• Open surgery offers better access but has longer recovery and more scarring.
• Non-surgical treatments can avoid surgical risks but may be less effective for certain cancer stages.

Patient Experience

During the Procedure:

• The patient is under general anesthesia and will not feel anything.

After the Procedure:

• Pain and discomfort at the incision sites, managed with medications
• Possible fatigue and general weakness for several weeks
• Instructions on wound care, activity restrictions, and signs of complications to watch for

Pain Management and Comfort Measures:

• Regular use of prescribed pain relievers
• Use of heat/ice packs as recommended
• Gradual increase in activity as tolerated and as per doctor’s advice