Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed
CPT4 code
Name of the Procedure:
Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral.
Summary
This procedure involves the surgical removal of the uterus, fallopian tubes, ovaries, and part of the omentum (a layer of the abdomen) through minimally invasive laparoscopic techniques. It is performed to remove malignant tumors and reduce the spread of cancer.
Purpose
The primary purpose of this procedure is to treat cancers of the reproductive organs by removing the primary tumor and any associated tissues to prevent the spread of the disease. The expected outcome is the reduction or elimination of cancerous cells from the body, aiming to improve the patient's prognosis and quality of life.
Indications
- Diagnosis of malignant tumors in the uterus, ovaries, or fallopian tubes.
- Symptoms such as unexplained pelvic pain, abnormal bleeding, or a swollen abdomen.
- The presence of cancer that requires debulking to facilitate further treatment, such as chemotherapy or radiation.
Preparation
- Patients are often instructed to fast for at least 8 hours before the procedure.
- Medication adjustments may be necessary, particularly blood thinners.
- Preoperative diagnostic tests might include blood tests, imaging studies (e.g., MRI, CT scans), and a comprehensive physical examination.
Procedure Description
- The patient is administered general anesthesia.
- Small incisions are made in the abdomen.
- A laparoscope (a thin, lighted camera) and surgical instruments are inserted through these incisions.
- The surgeon views the operative field on a monitor and performs the hysterectomy, removing the uterus, fallopian tubes, and ovaries.
- An omentectomy is performed to remove part of the abdominal lining.
- If necessary, lymph nodes and other tissues may be biopsied or removed.
- The incisions are closed with sutures or staples.
Duration
The procedure typically takes between 3 to 5 hours.
Setting
The procedure is performed in a hospital's operating room or a specialized surgical center.
Personnel
- Surgeons specialized in oncology and gynecology.
- Anesthesiologists to manage anesthesia.
- Surgical nurses and operating room technicians.
- Postoperative care staff including nurses and recovery room personnel.
Risks and Complications
- Common risks: bleeding, infection, reactions to anesthesia.
- Rare risks: injury to surrounding organs (bladder, bowels), blood clots, issues related to wound healing.
- Management may involve medications, additional surgeries, or other interventions.
Benefits
- Removal of cancerous tissues improving the chances of recovery and survival.
- Alleviation of symptoms caused by the tumor.
- Potentially reduced need for aggressive follow-up treatments.
Recovery
- Patients may stay in the hospital for 1-2 days post-procedure.
- Recovery time is typically 4-6 weeks.
- Post-surgery instructions include rest, avoiding heavy lifting, and gradually resuming normal activities.
- Follow-up appointments are necessary to monitor healing and response to treatment.
Alternatives
- Radiation therapy: Effective for some cancers but may not stop spread.
- Chemotherapy: Can be used alone but is often more effective post-surgery.
- Medications: Hormonal therapies may be an option for certain cancers.
Pros and cons of alternatives vary by patient condition; surgical removal might offer more immediate results but comes with surgical risks that non-invasive treatments do not.
Patient Experience
Patients will be under anesthesia during the procedure, so they will not feel anything. Post-surgery, they may experience pain, discomfort, or bloating which can be managed with prescribed pain relief medications and supportive care. Emotional support and clear communication with the healthcare team are important for a positive recovery experience.