rockylopez
Networker
Hello everyone. I need input. I am aware that lap ovarian cystectomy is 58662. can someone give me advice if this code includes evacuation of hemoperitoneum.
Operative Note
Pre-Op Diagnosis: hemorrhagic cyst with hemoperitoneum
Post-Op Diagnosis: same as pre-op
Procedure: laparoscopic L ovarian cystectomy with evacuation of hemoperitoneum
Anesthesia: General
EBL: 100 mL: Hemoperitoneum 1 L
Specimens: Left ovarian cyst
Findings: Large hemoperitoneum extending into bilateral upper quadrants, large left ovarian cyst
Complications: none
Procedure:
The patient was taken to the operating room where general anesthesia was obtained without difficulty. The patient was positioned in Allen stirrups. The patient was then prepped and draped in typical fashion. A catheter was placed to drain the bladder. A bivalve speculum was then inserted to allow visualization of the cervix. A single-tooth tenaculum was placed to allow mobilization of the uterus and cervix. The speculum was removed. Attention was then turned to the patient's abdomen. A kelly clamp was used to separate the anterior and posterior portions of the umbilical fold. The scalpel, an 11 blade, was then used to make a 5mm incision inside the inferior portion of the umbilical fold. The veress needle was introduced and intraperitoneal localization confirmed with water droplet testing and initial insufflation pressure of 5mmHg. The abdomen was insufflated to a pressure of 15mmHg. Inspection revealed the large collection of blood and clots in the peritoneum limiting visualization of the pelvic anatomy. Bilateral lower quadrant 5mm trocars were then placed to assist in manipulation, suction, and removal of clots. The patient was placed in Trendelenburg and suction irrigation was used to allow visualization of the left adnexa. No visible perforation/rupture of cyst was noted on inspection. A puncture was made into the ovarian cyst surface and clear fluid noted to drain. The suction irrigator was placed within the defect and used to deflate the cyst. The cyst wall was then grasped with a forceps and another forceps used to apply countertraction. The cyst wall was removed from the ovarian serosa. The ovary was stuffed with Surgicel and hemostasis confirmed. Attempts to remove the specimen through an 5 mm Endo Catch bag were unsuccessful. The umbilical incision was then extended and a 10 mm trocar inserted. A larger bag was then used to fit the previous 5 mm bag containing the specimen and removed through the umbilicus along with the trocar. The umbilical port site had to be extended to allow complete removal of the bag and the specimen. Copious irrigation and suction were then carried out for over 60 minutes to remove the majority of the blood and clots noted on inspection. Hemostasis was confirmed. The umbilical fascial incision was then reapproximated using the Carter Thompson and 0 Vicryl. The abdomen insufflation was discontinued and the trocars removed. The trochar sites were reapproximated with 4-0 monocryl and dermabond. Local anesthesia was injected below trochar incision sites. The patient tolerated the procedure well. The patient was awakened and taken to the recovery room in stable condition.
Operative Note
Pre-Op Diagnosis: hemorrhagic cyst with hemoperitoneum
Post-Op Diagnosis: same as pre-op
Procedure: laparoscopic L ovarian cystectomy with evacuation of hemoperitoneum
Anesthesia: General
EBL: 100 mL: Hemoperitoneum 1 L
Specimens: Left ovarian cyst
Findings: Large hemoperitoneum extending into bilateral upper quadrants, large left ovarian cyst
Complications: none
Procedure:
The patient was taken to the operating room where general anesthesia was obtained without difficulty. The patient was positioned in Allen stirrups. The patient was then prepped and draped in typical fashion. A catheter was placed to drain the bladder. A bivalve speculum was then inserted to allow visualization of the cervix. A single-tooth tenaculum was placed to allow mobilization of the uterus and cervix. The speculum was removed. Attention was then turned to the patient's abdomen. A kelly clamp was used to separate the anterior and posterior portions of the umbilical fold. The scalpel, an 11 blade, was then used to make a 5mm incision inside the inferior portion of the umbilical fold. The veress needle was introduced and intraperitoneal localization confirmed with water droplet testing and initial insufflation pressure of 5mmHg. The abdomen was insufflated to a pressure of 15mmHg. Inspection revealed the large collection of blood and clots in the peritoneum limiting visualization of the pelvic anatomy. Bilateral lower quadrant 5mm trocars were then placed to assist in manipulation, suction, and removal of clots. The patient was placed in Trendelenburg and suction irrigation was used to allow visualization of the left adnexa. No visible perforation/rupture of cyst was noted on inspection. A puncture was made into the ovarian cyst surface and clear fluid noted to drain. The suction irrigator was placed within the defect and used to deflate the cyst. The cyst wall was then grasped with a forceps and another forceps used to apply countertraction. The cyst wall was removed from the ovarian serosa. The ovary was stuffed with Surgicel and hemostasis confirmed. Attempts to remove the specimen through an 5 mm Endo Catch bag were unsuccessful. The umbilical incision was then extended and a 10 mm trocar inserted. A larger bag was then used to fit the previous 5 mm bag containing the specimen and removed through the umbilicus along with the trocar. The umbilical port site had to be extended to allow complete removal of the bag and the specimen. Copious irrigation and suction were then carried out for over 60 minutes to remove the majority of the blood and clots noted on inspection. Hemostasis was confirmed. The umbilical fascial incision was then reapproximated using the Carter Thompson and 0 Vicryl. The abdomen insufflation was discontinued and the trocars removed. The trochar sites were reapproximated with 4-0 monocryl and dermabond. Local anesthesia was injected below trochar incision sites. The patient tolerated the procedure well. The patient was awakened and taken to the recovery room in stable condition.