bladder dissection

[karra@bluemarble.net]

Can you help me code this bladder dissection:
I would sure appreciate it.

PREOPERATIVE DIAGNOSIS: Sigmoid cancer.
POSTOPERATIVE DIAGNOSIS: Sigmoid cancer.
OPERATION PERFORMED: Sigmoid collectomy. I performed a dissection of
posterior bladder wall from tumor and irrigation of catheter.
SURGEON:
ANESTHESIA: General.
INDICATIONS: This gentleman was undergoing a sigmoid colectomy by Dr. for very large aggressive sigmoid tumor. At the time of dissection, the bowel
was grossly adherent to the posterior wall of the, Dr. began dissection
but thought it prudent to call urology for complete dissection of the bladder.
PROCEDURE: I scrubbed into the case and assisted Dr. in dissecting a
plane that appeared to be either cancer or phlegmon from the bladder. I
actually pulled the peritoneal wall off of the reflection of the bladder down
the detrusor, all the way underneath to the ampulla of the vasa differentia
posterior to the bladder where I cut it with an ENSEAL device, freeing up the
mesentery of the sigmoid colon. Dr. then proceeded with a sigmoid
colectomy. This will all be dictated under separate heading. After the
sigmoid colectomy the specimen was opened grossly and it was growing into the
wall of the sigmoid colon but not grossly through the wall. Still I went back
and examined the area of resection in the posterior bladder. Several bites of
this were taken, including one on either side of the resected area and one at
the base of the resected area. These were sent for frozen specimen, which I
reviewed with the pathologist. All of this came back fibroblastic reaction
but no tumor. I, therefore, went back and examined the wound and a 20-French
Foley catheter was then placed into the penis on the field and the bladder
irrigated. The bladder was completely intact. I traced the ureters down on
either side. The right ureter was well out of the field. The left ureter was
very close to the resected margin, but was unaffected grossly.
Dr. and I then consulted and under the circumstances felt that
additional dissection of the bladder was unnecessary, given the nature of the
patient's cancer and probable need for additional chemotherapy and radiation
and probable inability to completely, if there is tumor involved, that this
margin to completely resect it without doing a cystectomy. However, grossly
there was no tumor and microscopically there was no additioanl tumor either,
so we felt comfortable leaving things alone. To that end, I turned the case
back over to Dr. , who would initiate closure.