Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s)
CPT4 code
Name of the Procedure:
Total Abdominal Hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s)
Summary
A total abdominal hysterectomy is a surgical procedure to remove the uterus through an incision in the abdomen. This procedure can also include the removal of part of the vagina, lymph nodes from the area around the aorta and the pelvis, and possibly the fallopian tubes and ovaries.
Purpose
The primary goal of this procedure is to treat conditions affecting the uterus, such as cancer, severe endometriosis, or fibroids. The procedure aims to remove diseased tissue, alleviate symptoms, and prevent the spread of cancer.
Indications
- Uterine cancer
- Persistent, severe endometriosis
- Large or symptomatic fibroids
- Chronic pelvic pain
- Heavy bleeding unresponsive to other treatments
- Precancerous conditions or severe dysplasia
Preparation
Patients are typically instructed to:
- Fast for 12 hours before the procedure
- Follow specific medication instructions (e.g., stopping blood thinners)
- Undergo diagnostic tests such as blood work, imaging studies, or a pre-operative physical exam
Procedure Description
- Preoperative Preparation: The patient is placed under general anesthesia.
- Incision: A horizontal or vertical incision is made in the lower abdomen.
- Removal of Uterus: The uterus is carefully separated from surrounding tissues and removed.
- Partial Vaginectomy: Part of the vagina may also be removed, depending on the condition treated.
- Lymph Node Sampling: Lymph nodes from the pelvic and para-aortic regions are sampled to check for the spread of disease.
- Optional Removal of Tubes/Ovaries: Fallopian tubes and/or ovaries may be removed if necessary.
- Closure: The incision is closed with sutures or staples.
Duration
The procedure typically takes between 2 to 4 hours.
Setting
Total abdominal hysterectomy is performed in a hospital operating room.
Personnel
- Surgeon (usually a gynecologist or oncologist)
- Anesthesiologist
- Surgical nurses
- Scrub technicians
Risks and Complications
- Infection
- Bleeding or blood clots
- Damage to surrounding organs (bladder, bowel, etc.)
- Reactions to anesthesia
- Longer-term complications such as hormonal changes, if ovaries are removed
Benefits
- Relief from chronic pain and bleeding
- Treatment or removal of cancerous tissues
- Reduction in the risk of cancer spreading
- Improved quality of life
Recovery
- Hospital stay of 1 to 3 days post-surgery
- Pain management through prescribed medications
- Avoid heavy lifting and strenuous activities for 6 to 8 weeks
- Gradual return to normal activities as instructed by the surgeon
- Follow-up appointments to monitor healing
Alternatives
- Medications for symptom management
- Less invasive surgical procedures (e.g., laparoscopy)
- Radiation or chemotherapy (for cancer treatment)
- Uterine artery embolization (for fibroids)
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel pain. Post-surgery, patients may experience pain and discomfort at the incision site, which can be managed with medications. Full recovery can take several weeks, and patients should follow their doctor's instructions for a smooth recovery.