Wiki HELP !!!!removal essure with salpingectomy including cornual portion????


Estero, FL
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laproscopic removal of essure device with total salpingectomy including cornual porti

I have searched all over the internet with no luck. Any help would be greatly appreciated. I am thinking I may have to use the unlisted code of 58578.?????????

PROCEDURE: After adequate anesthesia was obtained, the patient was sterilely prepped and draped in the dorsal lithotomy position. The cervix was carefully dilated and hysteroscopy was performed revealing bilateral tubal ostia visible with only the very tip of the Essure device on the left tube being visible inside the tube with no graspable piece of the device present on either tube. A fractional D&C was performed and tissue was sent to Pathology. The remainder of the uterine examination revealed no lesions within the uterine cavity, no polyps, no adhesions or other lesions present. A manipulator was placed in the uterus. Laparoscopy was begun with an incision in the umbilicus. Two Kochers were used to lift the fascia which was then incised with a scalpel. The peritoneum was then entered with the hemostat. The laparoscopic cannula was inserted bluntly. Good pneumoperitoneum was achieved and second punctures were placed above the pubis in the midline and the left lower quadrant lateral to the inferior epigastric vessels. The pelvis was thoroughly inspected. There was no evidence of any endometriosis, adhesions or cause for any pelvic pain or pathology. The proximal portion of each tube was noted to be slightly distended by the Essure devices and there was no abnormal perforation of the tube on either side or any evidence of any trauma from the devices. There was some question about the possibility of a mild nickel allergy by the patient and, therefore, we continued to remove the devices, as was her desire. The proximal tube and cornua were coagulated with the Thunderbeat bipolar cautery on each side and also the mesosalpinx was coagulated with both bipolar cautery on the right tube completely cauterizing and then resecting the tube along the mesosalpinx including the entire fimbria and the entire cornual portion of the tube. The cornual portion of the tube was left intact on the uterus after dividing just distal to the Essure device. The Essure device was then located with
the Maryland grasper and was removed first removing the tip of the device, then the wire coil and also the fiber portion of the device, completely accounting for the entire device with no fragments remaining behind. The remainder of the cornual stump of the tube was excised using the Thunderbeat cautery and cutting device. The same exact procedure was performed on the left tube with first resecting the tube along the mesosalpinx with the Thunderbeat device and then dividing the tube from the cornual portion and then removing the entire Essure device including the outer string, the internal fiber and both tips of the device. All pieces were totally accounted for and removed. The stump was removed from the cornual area. All bleeding was controlled with needlepoint cautery and the bipolar cautery with the Thunderbeat instrument. She tolerated the procedure well. The pelvis was thoroughly irrigated and suctioned. Blood loss was less than 50 mL. The pelvis was thoroughly irrigated. A Valsalva maneuver was used to help to remove CO2 from the abdomen and pelvis. The incisions were then closed with 4-0 Vicryl subcuticular stitches. She tolerated the procedure well and was transported to the Recovery Room in good condition.

Thank you for your help