Hmmm new one for me. Was anything else done?? Did the patient have a prior supracervical hysterectomy?? What was the approach??
Maybe 57520 for conization??? This seems likely to be unlisted, and comparison options from 57500-57558 depending on what exactly was done.
Thank you Christine.
Patient also had
Colpopexy, enterocele repair, anterior colporrhaphy, vaginal reconstruction, perineoplasty, cystoscopy.
DESCRIPTION OF PROCEDURE: Patient was taken to the operating room
where anesthesia was induced. She was placed in high dorsal
lithotomy position with careful attention to not hyperflex,
hyperabduct or hyper-externally rotate the leg. This positioning was
performed directly by myself. She was examined under anesthesia with
the findings noted as above. Time-out was performed. She was
prepped and draped in the usual sterile fashion. Catheter to gravity
was used to empty the bladder yielding 100 mL of clear urine. At
this point, we proceeded to anterior colporrhaphy. Local injection
was performed along the cystocele track. Vaginal epithelium was
excised sharply and dissected from underlying endopelvic connective
tissue at the pubocervical fascia, dissecting sharply down to the
sacrospinous ligament coccygeus complex. Using catch-release
mechanism, an Ethibond
suture was placed along the midportion of the
coccygeus sacrospinous ligament complex, first on the patient's right
and on the left side, using polydioxanone, a suture was placed along
the midportion using catch release mechanism. These sutures were
carried out on the right side through the cervix, cervical ring as
well as the vaginal epithelium and on the left it was carried out
through the vaginal epithelium in the remaining cervix, cervical
ring. I proceeded to imbricate the endopelvic connective tissue of
the pubocervical fascia in a transverse horizontal mattress fashion
including the cystocele, vagina, vaginal epithelium redundancy was
trimmed aggressively and closed with a 2-0 Vicryl suture in a running
unlocked fashion. The cervix was noted to be hyper-elongated and
this was partial excised, approximately 2 cm at the anterior lip of
the cervix was excised. Sutures were placed to promote hemostasis.
Suspension sutures were tied and held under tension. Under direct
visualization of the ureters using cystoscope, cystoscopy
demonstrated no trauma lesions. Bladder and bilateral ureteric
efflux. Suspension sutures were tied with excellent suspension. At
this point, attention was turned to the posterior aspect. Vaginal
reconstruction was performed. Elliptical incision was used to enter
the posterior compartment. Vaginal epithelium was sharply dissected
off and bluntly dissected off underlying rectovaginal septum,
endopelvic connective tissue, the rectovaginal septum. 0 Vicryl
suture was used in a vertical mattress fashion to create a tightening
effect. Redundant vaginal epithelium was resected along both the
right and left portions and the anterior portion perineum was _____
bulbocavernosus was imbricated in the midline followed by transverse
perinei. Vagina was closed with 2-0 Vicryl suture in a running
locked fashion. Patient tolerated procedure well. Sponge, lap,
needle, instrument count were correct x2. She was taken to the
recovery room in stable condition.