# lap colectomy or lap converted to open???



## Leanne (Jan 28, 2010)

I'm not sure if I should code as 44145 or 44207 

Procedure: Laparoscopic sigmoid resection w/ colorectal anastamosis.

"...12-mm incision made in mid right abdomen thru which 12-mm trocar placed laparoscopically.  Pneumoperitoneum created and 5-mm suprapubic and mid epigastric trocars placed....Exploration confirmed easily seen black spot on sigmoid colon w/ pandemic sigmoid diverticulosis...Decision made to perform laparoscopic-assisted sigmoid resection....entire specimen mobilized...We made a lower midline 8cm incision thru which entire sigmoid colon was delivered...The descending colon, sigmoid junction was identified, transected with GIA staple device...The rectal mesentery was taken w/ the Harmonic scalpel and TA-60 staple device transected the rectum about 4cm beyond sigmoid colon for generous nodal dissection.

...At this time since he was in low lithotomy position, we decided to perform a transanal stapled colorectal anastamosis...the staple line of descending colon was opened and 31mm diameter anvil slipped into this and the staples fired once again....the staple again placed through anus, through the rectum popping out through the center of the rectal staple line...anvil was snapped on, stapled then tightened and gun fired.  Two doughnuts removed...air test confirmed complete air tight...abdominal contents returned and attention turned to closure.

...Repeat insufflation confirmed complete hemostasis...Trocars removed under direct vision and trocar sites closed in similar fashion..."


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