Alfaro33
Networker
Having trouble finding a code for this procedure. MD using 49329 Unlisted laparoscopy procedure, abdomen, peritoneum and omentum. Any help would be appreciated.
Date of Surgery
01/29/2021
Preoperative Diagnosis
right pelvic mass
Postoperative Diagnosis
likely granulosa cell tumor
Operation
robotic hysterectomy, bso, partial omentectomy
Anesthesia
gen
Technique
She presented to me with a new diagnosis of adnexal mass. Risks benefits and alternatives the above-noted procedure discussed with patient. Patient gave written and verbal consent.
Patient was taken the operating room patient in dorsal supine position. General anesthesia was initiated. Patient was then placed in lithotomy position. Patient was then draped and prepped in a normal sterile fashion. Attention was then turned to the pelvic part of the procedure. A Foley catheter was placed under sterile technique. Cervix was grasped with a single-tooth tenaculum. It was sounded 10 cm. The uterine manipulator was inserted. Attention was then turned to the abdomen. A 5 mm incision was made in the left upper quadrant. Under direct visualization a Visiport was placed into the abdominal cavity. Additional trocar sites were placed in the right and left mid upper quadrants and supraumbilically. The patient was placed in steep Trendelenburg. Pelvic washings were obtained. The robot was docked appropriately.
Attention was then turned to the console. The round ligaments and IP ligaments were ligated bilaterally. The pelvic sidewalls were entered bilaterally. Sentinel The bladder flap was then created sharply. Uterine arteries were skeletonized and ligated bilaterally. Serial bites were taken along the cardinal ligaments down to the level of vagina. The specimen was then amputated. The specimen was delivered vaginally. the ovary was sent for frozen. as above. omental resection was performed with care not to enter underlying bowel. removed thru vagina. After the specimen was removed the vaginal cuff was reapproximated with 0 vlock suture. Hemostasis confirmed. The robot was undocked. Hemostasis confirmed. At this point drapes removed lap sponge needle counts were correct x2. The patient was taken out of general anesthesia and taken to recovery room stable condition. I was present scrubbed for the entire procedure.
Estimated Blood Loss
100
Findings
8 cm rt adnexal mass, frozen likley granulosa cell tumor
Specimen(s)
uterus, tubes ovaries, cervix, omentum
Complications
none
Date of Surgery
01/29/2021
Preoperative Diagnosis
right pelvic mass
Postoperative Diagnosis
likely granulosa cell tumor
Operation
robotic hysterectomy, bso, partial omentectomy
Anesthesia
gen
Technique
She presented to me with a new diagnosis of adnexal mass. Risks benefits and alternatives the above-noted procedure discussed with patient. Patient gave written and verbal consent.
Patient was taken the operating room patient in dorsal supine position. General anesthesia was initiated. Patient was then placed in lithotomy position. Patient was then draped and prepped in a normal sterile fashion. Attention was then turned to the pelvic part of the procedure. A Foley catheter was placed under sterile technique. Cervix was grasped with a single-tooth tenaculum. It was sounded 10 cm. The uterine manipulator was inserted. Attention was then turned to the abdomen. A 5 mm incision was made in the left upper quadrant. Under direct visualization a Visiport was placed into the abdominal cavity. Additional trocar sites were placed in the right and left mid upper quadrants and supraumbilically. The patient was placed in steep Trendelenburg. Pelvic washings were obtained. The robot was docked appropriately.
Attention was then turned to the console. The round ligaments and IP ligaments were ligated bilaterally. The pelvic sidewalls were entered bilaterally. Sentinel The bladder flap was then created sharply. Uterine arteries were skeletonized and ligated bilaterally. Serial bites were taken along the cardinal ligaments down to the level of vagina. The specimen was then amputated. The specimen was delivered vaginally. the ovary was sent for frozen. as above. omental resection was performed with care not to enter underlying bowel. removed thru vagina. After the specimen was removed the vaginal cuff was reapproximated with 0 vlock suture. Hemostasis confirmed. The robot was undocked. Hemostasis confirmed. At this point drapes removed lap sponge needle counts were correct x2. The patient was taken out of general anesthesia and taken to recovery room stable condition. I was present scrubbed for the entire procedure.
Estimated Blood Loss
100
Findings
8 cm rt adnexal mass, frozen likley granulosa cell tumor
Specimen(s)
uterus, tubes ovaries, cervix, omentum
Complications
none