HCPCS Procedure: Morcellator (C1782)

Name of the Procedure:

Common names: Morcellation, Tissue Morcellation Technical terms: Laparoscopic Morcellation, Hysteroscopic Morcellation

Summary

Morcellation is a medical procedure used to cut large tissues into smaller pieces, making it easier to remove them through small incision sites during minimally invasive surgeries. It's commonly used in laparoscopic surgeries like hysterectomies or myomectomies.

Purpose

Morcellation addresses conditions such as uterine fibroids, large non-cancerous tumors, and other bulky tissues requiring removal. The primary goal is to facilitate the removal of large tissues in a minimally invasive manner, leading to quicker recovery times and less post-surgical pain.

Indications

• Presence of symptomatic uterine fibroids (e.g., causing pain, heavy bleeding, or pressure).
• Large tissues that are difficult to remove in one piece during minimally invasive surgery.
• Patients needing a hysterectomy with an emphasis on minimally invasive techniques.

Preparation

• Patients may need to fast for at least 8 hours before the procedure.
• Adjustments to current medications, especially blood thinners, may be required.
• Pre-operative imaging and diagnostic tests like ultrasounds or MRIs.
• Consultation to discuss anesthesia options.

Procedure Description

1. The patient is positioned and prepped in a sterile environment.
2. Anesthesia is administered (options include general or regional anesthesia).
3. Small incisions are made to insert laparoscopic instruments.
4. A morcellator is introduced through one of the incisions.
5. The morcellator cuts the target tissue into smaller fragments.
6. These fragments are removed through the small incisions.
7. The surgical area is inspected for any remaining tissue fragments.
8. Incisions are closed, and the patient is moved to recovery.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity.

Setting

Morcellation is performed in hospital operating rooms or outpatient surgical centers equipped for minimally invasive surgery.

Personnel

• Surgeons specialized in minimally invasive or laparoscopic surgery
• Anesthesiologists
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks: bleeding, infection at the incision site.
• Rare risks: injury to surrounding organs, dissemination of undiagnosed cancerous tissues (if present), incomplete removal of the tissue.
• Management strategies: monitoring for signs of complications, immediate intervention if necessary.

Benefits

• Minimally invasive, leading to smaller incisions and less post-operative pain.
• Reduced recovery time compared to traditional open surgery.
• Quicker return to normal activities, generally within a few weeks.

Recovery

• Patients can expect to go home the same day or the following day.
• Post-procedure instructions include avoiding heavy lifting and strenuous activities for a few weeks.
• Pain management through prescribed medications.
• Follow-up appointments to monitor healing and address any concerns.

Alternatives

• Traditional open surgery, which involves larger incisions and longer recovery times.
• Medications to manage symptoms without surgical intervention.
• Non-invasive procedures like MRI-guided focused ultrasound.
• Pros and cons: Open surgery offers direct access to tissues but with more significant recovery; non-invasive methods may not be suitable for all cases.

Patient Experience

During the procedure, the patient will be under anesthesia and should experience no pain. Post-procedure, some discomfort, and mild pain are expected but can be managed with medications. Most patients can resume normal activities within a few weeks, following their healthcare provider’s instructions.