Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple
CPT4 code
Name of the Procedure:
Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple. Also known as laparoscopic lymphadenectomy or laparoscopic lymph node dissection.
Summary
Laparoscopy with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling is a minimally invasive surgical procedure where small incisions are made to remove lymph nodes from the pelvic area and around the aorta. This helps in diagnosing and treating cancers, such as gynecologic cancers.
Purpose
This procedure is often performed to diagnose, stage, and treat cancers affecting the pelvic region, like ovarian, uterine, or cervical cancer. By removing and examining the lymph nodes, doctors can determine if cancer has spread and plan further treatment accordingly.
Indications
- Abnormal lymph node enlargement detected via imaging.
- Suspected spread of pelvic malignancies like ovarian, uterine, or cervical cancer.
- Confirmation of cancer staging during or after initial treatment.
- Persistent pelvic pain or unexplained symptoms following cancer treatment.
Preparation
- Patients will need to fast for at least 8 hours before the procedure.
- Certain medications may need to be adjusted or stopped; patients should follow their doctor's instructions.
- Preoperative tests may include blood work, imaging studies (CT, MRI), and possibly biopsies.
Procedure Description
- The patient is given general anesthesia to ensure they are unconscious and pain-free during the procedure.
- Small incisions (usually 3-5) are made in the abdomen.
- A laparoscope (a thin tube with a camera and light) is inserted through one incision to provide a view of the internal organs on a monitor.
- Surgical instruments are inserted through the other incisions to perform the lymphadenectomy.
- The surgeon removes the lymph nodes from the pelvic region and around the aorta.
- Removed lymph nodes are sent to a laboratory for biopsy and pathological examination.
- The incisions are closed with sutures or surgical glue and covered with bandages.
Duration
The procedure typically takes 2-4 hours, depending on the complexity and number of lymph nodes removed.
Setting
This procedure is performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeon (usually a gynecologic oncologist)
- Anesthesiologist
- Surgical nurses
- Surgical assistants
- Pathologist (for biopsy analysis)
Risks and Complications
- Common: Infection, bleeding, pain at incision sites.
- Rare: Injury to nearby organs (bowel, bladder, blood vessels), blood clots, reactions to anesthesia, prolonged recovery.
Benefits
- Accurate staging and diagnosis of pelvic cancers.
- Minimally invasive with shorter recovery time compared to open surgery.
- Less postoperative pain and scarring.
- Early detection of cancer spread can lead to more effective treatment plans.
Recovery
- Patients can usually go home the same day or after a short hospital stay.
- Recovery time is typically 2-4 weeks.
- Post-procedure instructions include: avoiding heavy lifting, following prescribed pain management, and attending follow-up appointments.
- Patients should monitor for signs of infection or complications and report these to their doctor.
Alternatives
- Open surgical lymphadenectomy: More invasive with longer recovery.
- Imaging-based biopsy (CT-guided): Less invasive but may not be as comprehensive.
Observation and follow-up: For patients not fit for surgery or when immediate intervention isn't necessary.
Patient Experience
- During the procedure: Under general anesthesia, no sensation or awareness.
- After the procedure: Mild to moderate pain managed with medication, slight discomfort at incision sites, fatigue.
- Most patients can resume normal activities within a few weeks, with a significant improvement in symptoms and recovery over time.