Laparoscopy, surgical, colpopexy (suspension of vaginal apex)
CPT4 code
Name of the Procedure:
Laparoscopy, surgical, colpopexy (suspension of vaginal apex)
Common Names: Laparoscopic Colpopexy, Vaginal Apex Suspension
Summary
Laparoscopic colpopexy is a minimally invasive surgical procedure designed to correct pelvic organ prolapse by attaching the vaginal apex to the sacrum using a laparoscope. This suspension helps to restore normal anatomy and function.
Purpose
The procedure addresses pelvic organ prolapse, specifically uterine prolapse or vaginal vault prolapse post-hysterectomy. The goal is to provide support to the vaginal apex, alleviate symptoms like pelvic pressure, bladder issues, and improve overall quality of life.
Indications
- Symptoms of pelvic organ prolapse such as vaginal bulging, pelvic pressure, lower back pain, urinary incontinence, or dyspareunia.
- Patients with uterine prolapse or vaginal vault prolapse.
- Candidates for surgery who have not responded to conservative treatments such as pessaries or pelvic floor therapy.
Preparation
- Patients may be instructed to fast for 8 hours before the procedure.
- Medications may need to be adjusted or stopped, especially blood thinners.
- Pre-procedure diagnostic tests may include pelvic exams, ultrasound, or MRI.
- Bowel preparation might be required as instructed by the healthcare provider.
Procedure Description
- The patient is placed under general anesthesia.
- Small incisions are made in the abdomen.
- A laparoscope (a thin tube with a camera) is inserted to visualize internal structures.
- Additional small instruments are inserted through other incisions.
- The vaginal apex is attached to the sacrum using mesh or sutures to provide support.
- The instruments are removed and incisions are closed.
Tools and Equipment:
- Laparoscope
- Surgical instruments for cutting and suturing
- Surgical mesh (if used)
Duration
The procedure typically takes about 2 to 3 hours.
Setting
It is usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeon (typically a gynecologist or urogynecologist)
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Bleeding
- Infection
- Injury to surrounding organs (bladder, bowel)
- Mesh complications (erosion, exposure)
- Pelvic pain
- Recurrence of prolapse
Benefits
- Relief of prolapse symptoms
- Improvement in urinary and bowel function
- Enhanced quality of life
- Minimally invasive with shorter recovery time compared to open surgery
Recovery
- Most patients can go home the same day or after an overnight stay.
- Pain management includes oral pain relievers.
- Avoid heavy lifting and strenuous activity for 6 to 8 weeks.
- Follow-up appointments are necessary to monitor healing.
- Many return to normal activities within 4 to 6 weeks.
Alternatives
- Non-surgical options like pelvic floor physical therapy or pessary use.
- Open abdominal colpopexy or vaginal surgical procedures.
- Pros of alternatives include avoiding surgery (for conservative measures); cons include lower efficacy in severe cases.
Patient Experience
- During the procedure: Patients will be under general anesthesia and will not feel anything.
- After the procedure: Some pain and discomfort at the incision sites, managed with medication.
- Typical symptoms include mild cramping and bloating.
- Most experience significant symptom relief within a few weeks.