such78
Expert
POSTOPERATIVE DIAGNOSES: A 53-year-old female with BRCA1 positivity, history of breast cancer, and peritoneal carcinomatosis with extensive pelvic and bowel adhesions.
PROCEDURE PERFORMED: Exam under anesthesia, laparoscopy, peritoneal biopsies, and lysis of adhesions.
FINDINGS: On exam under anesthesia, patient had normal vulva, normal vaginal mucosa. Cervix was grossly normal, no nodularity or lesions. Uterus was fixed in the midline, and there was bilateral adnexal
fullness. However, size of adnexa was difficult to estimate based on exam. Intraoperatively, on entry into the abdomen, the patient had extensive walled-off adhesions with ascites trapped in compartments. The patient also had extensive adhesions with the bowel to the anterior abdominal wall and omentum. There was significant peritoneal carcinomatosis noted.
We began with exam under anesthesia with the findings noted above. We then turned our attention to the upper quadrant. I made a small incision in the left upper quadrant and advanced a 5 mm optical
trocar under direct visualization. Once intraperitoneal placement was confirmed, CO2 gas was used to insufflate the abdomen. I was able to find a small window away from bowel to place the scope, and we
immediately noted extensive adhesions that walled off multiple sections of the ascites. We freed up these adhesions releasing some of the ascites, which we suctioned and removed.
Once we had freed these adhesions after I placed a 5 mm trocar in the left mid quadrant, we were able to identify areas of peritoneal carcinomatosis, which I was able to biopsy without disturbing other tissue. I used the LigaSure device and the Endo Shear with good result. We removed 1 specimen for frozen section, and we removed another specimen for permanent histology. At this point, our procedure was concluded. Biopsies were collected. Specimens were sent. Adhesiolysis helped restore a portion of anatomy in the upper abdomen. However, this represented unresectable disease, likely stage IV disease, and she will need to undergo chemotherapy before any future larger surgical consideration will be made.
In path:
Omental biopsies: High grade serous carcinoma.
I have 49321 for biopsy and 49329 for pertoneum (omentum) extensive adhesion lysis.
Does 49329 include peritoneal biopsy?
Thank you for advices.
PROCEDURE PERFORMED: Exam under anesthesia, laparoscopy, peritoneal biopsies, and lysis of adhesions.
FINDINGS: On exam under anesthesia, patient had normal vulva, normal vaginal mucosa. Cervix was grossly normal, no nodularity or lesions. Uterus was fixed in the midline, and there was bilateral adnexal
fullness. However, size of adnexa was difficult to estimate based on exam. Intraoperatively, on entry into the abdomen, the patient had extensive walled-off adhesions with ascites trapped in compartments. The patient also had extensive adhesions with the bowel to the anterior abdominal wall and omentum. There was significant peritoneal carcinomatosis noted.
We began with exam under anesthesia with the findings noted above. We then turned our attention to the upper quadrant. I made a small incision in the left upper quadrant and advanced a 5 mm optical
trocar under direct visualization. Once intraperitoneal placement was confirmed, CO2 gas was used to insufflate the abdomen. I was able to find a small window away from bowel to place the scope, and we
immediately noted extensive adhesions that walled off multiple sections of the ascites. We freed up these adhesions releasing some of the ascites, which we suctioned and removed.
Once we had freed these adhesions after I placed a 5 mm trocar in the left mid quadrant, we were able to identify areas of peritoneal carcinomatosis, which I was able to biopsy without disturbing other tissue. I used the LigaSure device and the Endo Shear with good result. We removed 1 specimen for frozen section, and we removed another specimen for permanent histology. At this point, our procedure was concluded. Biopsies were collected. Specimens were sent. Adhesiolysis helped restore a portion of anatomy in the upper abdomen. However, this represented unresectable disease, likely stage IV disease, and she will need to undergo chemotherapy before any future larger surgical consideration will be made.
In path:
Omental biopsies: High grade serous carcinoma.
I have 49321 for biopsy and 49329 for pertoneum (omentum) extensive adhesion lysis.
Does 49329 include peritoneal biopsy?
Thank you for advices.