58960 Laparotomy, for staging or restaging of ovarian, tubal, or primary peritoneal malignancy (second look), with or without omentectomy, peritoneal washing, biopsy of abdominal and pelvic peritoneum, diaphragmatic assessment with pelvic and limited para-aorti

Name of the Procedure:

Laparotomy for Staging or Restaging of Ovarian, Tubal, or Primary Peritoneal Malignancy (Second Look)

• Common Names: Second-look Laparotomy, Exploratory Laparotomy
• Medical Term: Laparotomy

Summary

A laparotomy for staging or restaging ovarian, tubal, or primary peritoneal cancer involves making an incision in the abdomen to examine these areas. The surgeon may also remove the omentum, collect peritoneal washings, and take biopsies of the peritoneum for further analysis. This comprehensive examination helps determine the extent of disease spread.

Purpose

• Conditions Addressed: Detects or evaluates the recurrence of ovarian, tubal, or primary peritoneal malignancies.
• Goals: To stage or restage the cancer, assess the spread, gather necessary samples for pathology, and potentially treat affected areas.

Indications

• Symptoms/Conditions: Cancer diagnosis suspected or confirmed via imaging or prior surgery.
• Patient Criteria: Patients with known ovarian, tubal, or peritoneal cancer needing staging/restaging, especially if initial treatment outcomes are uncertain.

Preparation

• Pre-procedure Instructions: Fasting for at least 8 hours prior, stopping certain medications as instructed by the healthcare provider.
• Diagnostic Tests: Blood tests, imaging studies (CT scans, MRIs), and sometimes preoperative laparoscopic examination.

Procedure Description

• Steps:
  1. General anesthesia is administered.
  2. A midline incision is made in the abdominal wall.
  3. The surgeon examines the abdominal and pelvic organs.
  4. The omentum may be removed.
  5. Peritoneal washings are obtained by rinsing the peritoneal cavity with saline.
  6. Biopsies of suspicious areas and peritoneal surface are taken.
  7. Diaphragmatic surfaces are assessed.
  8. The incision is closed in layers.
• Tools and Equipment: Surgical scalpel, retractors, biopsy forceps, saline solution for washings, sutures.
• Anesthesia: General anesthesia throughout the procedure.

Duration

Typically takes 2 to 4 hours, depending on the extent of necessary assessments and interventions.

Setting

Performed in a hospital's operating room.

Personnel

• Surgeon: Ovarian or general surgical oncologist.
• Nurses: Surgical nurses assisting during the procedure.
• Anesthesiologist: Manages anesthesia and patient’s vital signs.

Risks and Complications

• Common Risks: Bleeding, infection, and pain at the incision site.
• Rare Complications: Injury to nearby organs (bowel, bladder), blood clots, and complications from anesthesia.

Benefits

• Provides precise staging or restaging information, guiding further treatment.
• Helps in obtaining pathology specimens to personalize treatment plans.
• Potentially treats discovered cancerous areas during the procedure.

Recovery

• Post-procedure Care: Pain management with medications, monitoring for signs of infection, encouragement to ambulate early.
• Recovery Time: Hospital stay of 3-5 days on average, with full recovery in 6-8 weeks.
• Follow-Up: Regular check-ups with the healthcare provider, including wound assessments and imaging tests.

Alternatives

• Other Options: Imaging studies alone (MRI, CT scans), laproscopy which is less invasive.
• Pros and Cons: Less invasive options involve fewer risks but might provide less detailed information. Laparotomy offers comprehensive assessment at the cost of higher risk and longer recovery.

Patient Experience

• During Procedure: Patient is under general anesthesia and will feel no pain or awareness.
• After Procedure: Pain at the incision site managed with pain relievers; feeling of tiredness and need for gradual return to normal activities. Frequent assessments and monitoring in the hospital for a few days.

Pain management strategies include prescribed medications and supportive care measures.