Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)

CPT4 code

Name of the Procedure:

Laparoscopy, Surgical, with Total Hysterectomy, for Uterus 250g or Less; with Removal of Tube(s) and/or Ovary(s)

Summary

This minimally invasive surgical procedure involves the removal of the uterus, and possibly one or both fallopian tubes and ovaries, through small incisions in the abdomen. It is completed using a laparoscope, a thin tube with a camera.

Purpose

This procedure aims to treat various gynecological conditions, such as uterine fibroids, endometriosis, chronic pelvic pain, and gynecologic cancers. The goal is to alleviate symptoms, improve quality of life, and sometimes prevent the spread or recurrence of cancer.

Indications

Symptomatic fibroids causing pain or heavy bleeding
Endometriosis unresponsive to other treatments
Chronic pelvic pain
Uterine, ovarian, or fallopian tube cancer
Severe abnormal uterine bleeding
Prolapsed uterus

Preparation

Fast for 8-12 hours before the procedure
Adjust or stop certain medications as directed by the doctor
Undergo preoperative diagnostic tests, such as blood tests, ultrasound, or a pelvic exam

Procedure Description

General anesthesia is administered.
Small incisions are made in the abdomen.
A laparoscope is inserted through one incision to provide a visual guide.
Surgical instruments are inserted through other incisions.
The uterus is detached and removed through the incisions.
If necessary, one or both fallopian tubes and/or ovaries are also removed.
Incisions are closed with sutures or surgical glue.

Duration

The procedure typically takes between 2-3 hours.

Setting

Performed in a hospital or surgical center.

Personnel

Surgeon (gynecologist specializing in laparoscopic surgery)
Anesthesiologist
Surgical nurses
Possibly a surgical assistant

Risks and Complications

Common: infection, bleeding, pain, adverse reaction to anesthesia
Rare: injury to surrounding organs (bladder, bowel), blood clots, hernia, long-term complications

Benefits

Relief from symptoms like pelvic pain or heavy bleeding
Potential cure or prevention of cancer
Minimally invasive approach results in less postoperative pain and quicker recovery
Shorter hospital stay compared to open surgery

Recovery

Most patients can go home the same day or within 24 hours
Recovery typically takes 2-4 weeks
Post-procedure instructions include rest, avoiding heavy lifting, and managing pain with prescribed medications
Follow-up appointments to monitor healing

Alternatives

Medication therapy for symptom management
Hormone treatments
Endometrial ablation for abnormal bleeding
Myomectomy for fibroid removal while preserving the uterus
Traditional open hysterectomy

Patient Experience

Patients may experience discomfort, pain, and fatigue initially, managed with pain-relief medications. Small scars and slight bruising at incision sites are common. Proper rest and following post-procedure instructions promote smoother recovery.