Name of the Procedure:

Common Name: Surgical Tissue Localization and Excision
Technical Term: Surgical tissue localization and excision device (implantable)
HCPCS Code: C1819

Summary

This procedure involves the use of an implantable device to precisely locate and then surgically remove tissue that may be abnormal, such as a tumor or other suspicious growth. The device helps doctors pinpoint the exact location of the tissue, making the surgical procedure more accurate.

Purpose

Medical Conditions Addressed:

• Suspicious lumps or tumors
• Abnormal tissue growths

Goals:

• Accurate localization and removal of abnormal tissues
• Minimize removal of healthy tissue
• Improve surgical outcomes

Indications

Symptoms and Conditions:

• Suspicious mammographic findings
• Palpable lumps that cannot be precisely located without guidance
• Non-palpable breast lesions needing biopsy or excision

Patient Criteria:

• Patients with abnormal imaging results
• Patients requiring accurate excision of sub-quarter-inch lesions

Preparation

Pre-procedure Instructions:

• Fasting for a specified period (usually 6-8 hours) before surgery
• Instructions on medication adjustments, including blood thinners
• Pre-operative imaging studies such as mammograms or ultrasounds

Diagnostic Tests:

• Mammogram, ultrasound, or MRI to identify the lesion
• Blood tests to evaluate overall health and readiness for surgery

Procedure Description

1. Localization:
   • The surgeon or radiologist inserts a needle or wire into the breast to the site of the lesion, guided by imaging studies.
   • An implantable marker may be placed at the tissue site to aid in precise excision.
2. Excision:
   • The patient is taken to the operating room.
   • General or local anesthesia is administered.
   • A surgical incision is made at the site, and the abnormal tissue is carefully excised, using the localization device as a guide.
3. Completion:
   • The incision is closed with sutures.
   • The tissue is sent to pathology for further examination.

Tools Used:

• Localization needle or wire
• Imaging equipment (ultrasound, mammogram)
• Standard surgical instruments

Anesthesia:

• Local or general anesthesia depending on the case

Duration

The procedure usually takes about 1 to 2 hours.

Setting

Typically performed in an outpatient clinic, surgical center, or hospital operating room.

Personnel

• Surgeon
• Radiologist
• Anesthesiologist or nurse anesthetist
• Surgical nurses
• Technologists for imaging guidance

Risks and Complications

Common Risks:

• Infection
• Bleeding or hematoma
• Pain at the incision site

Rare Risks:

• Incorrect localization leading to incomplete excision
• Adverse reactions to anesthesia
• Damage to surrounding tissues

Complications Management:

• Prompt treatment of infections with antibiotics
• Pain management strategies
• Follow-up imaging for surgical accuracy

Benefits

Expected Benefits:

• Precise removal of abnormal tissue
• Reduced likelihood of needing further surgeries
• Faster recovery due to minimally invasive technique

Timeframe for Benefits:

• Immediate post-surgery

Recovery

Post-Procedure Care:

• Rest and avoid strenuous activity
• Keep the surgical site clean and dry
• Follow-up appointments for wound check and pathology results

Expected Recovery Time:

• 1 to 2 weeks for initial recovery
• Some restrictions for up to 4 to 6 weeks

Restrictions and Follow-up:

• Limited physical activity
• Regular follow-ups for wound assessment and pathology discussion

Alternatives

Other Treatment Options:

• Traditional surgical biopsy without localization
• Fine-needle aspiration biopsy
• Core needle biopsy

Pros and Cons:

• Traditional surgery may remove more tissue
• Needle biopsies are less invasive but may not provide definitive diagnosis

Patient Experience

During the Procedure:

• Might feel pressure or discomfort during localization
• Anesthesia ensures a pain-free surgical experience

After the Procedure:

• Mild pain managed with over-the-counter analgesics
• Possible bruising or swelling at the incision site
• Supportive garments may be recommended for comfort

Pain Management:

• Prescription pain relievers if necessary
• Cold packs to reduce swelling

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