# laparoscopic ureteral re-implantation, neo-cystotomy...



## umcanes4 (Dec 20, 2018)

hello everyone!!! I was wondering if anyone can guide me in the right direction for this surgery that I have never coded  

I was looking at maybe 50948-RT? Thank you in advance. I always get nervous with procedures I have not seen before. 

_Procedure Name: Elective Right robotic laparoscopic ureteral re-implantation, neo-cystotomy, bladder psoas hitch, right ureteral stent exchange. 

Procedure Description: Pt was taken to the OR, induced under general anesthesia and then positioned in dorsal lithotomy. The pt was then repositioned into modified dorsal lithotomy position and placed in trendelenberg position. The pt was then prepped and draped. A robotic laparoscopic pelvic approach was utilized (5 ports - four 8mm ports, one 5mm port). The first port was placed using the veress needle and direct visual guidance. The remaining ports were placed under visual guidance. Attention was now focused on the right distal ureter. It was carefully dissected and ended into a scarred area near the pelvic brim. The bladder was also dissected free and a site on the dome chosen for the re-impant site. The distal right ureter was then ligated with care taken to preserve the ureteral stent. A psoas hitch was performed to bring the bladder dome to the right psoas muscle using a 2-0 vicryl suture. A small 1cm incision was created in the bladder dome as the site for the re-implant. The healthy proximal distal ureter was then re-anastomosed to this new bladder dome implant site using 2-0 vicryl sutures. A water tight anastomosis was created. The bladder was insufflated with indigo carmine tainted saline and no leak was noted. The bladder was drained. A lake drain was placed in the lower pelvis. The ports were then all removed and the wounds all closed. The skin closed was using 4-0 monocryl & skin glue.  
The pt was then extubated and transferred to PACU/recovery in stable condition. _


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## Machelle Freeman (Dec 21, 2018)

I am thinking more of 50947-RT. As there is a stent exchange.

Machelle Freeman, CPC


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## umcanes4 (Dec 21, 2018)

Thank you so much Machelle!! See that was my first thought but then he doesn't describe the stent exchange. Or do I take it from the part where he states "The distal right ureter was then ligated with care taken to preserve the ureteral stent."


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## Machelle Freeman (Dec 21, 2018)

umcanes4 said:


> Thank you so much Machelle!! See that was my first thought but then he doesn't describe the stent exchange. Or do I take it from the part where he states "The distal right ureter was then ligated with care taken to preserve the ureteral stent."



I see that now, I assumed he did it before the surgery, but I don't see it cited nor a cysto. So, actually use what you were thinking 50948. Sorry, for not catching that.

Machelle Freeman- CPC


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## umcanes4 (Dec 26, 2018)

Oh no THANK YOU for the help!!! I really appreciate it. HAPPY NEW YEAR!!


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