transanal endoscopic resection of rectal mass with a twist

rykin7609

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Has anyone ever heard of your doc doing a transanal endoscopic resection of a rectal mass or polyp (45171 or 45172) but also came in laparscopically? I am thinking I will need an unlisted code but I was wondering if anyone else had ever come across this?

Procedure notes:

first co surgeon

After induction of adequate endotracheal anesthesia, we performed the rigid proctoscopy while still on the transfer cart. I was able to pass the rigid scope and encountered the mass at approx. 8 cm. It was lying anteriorly. There was no ongoing bleeding noted, but the mass did appear large and friable. We them withdrew the scope. The patient was moved over to the operating table, placed in prone jackniife position. All pressure points were padded. The buttocks were taped apart and then prepped and draped sterily. We then proceeded with the transanal endoscopic resection. (Then it goes on to say to look at the other surgeon's dictation for further details.

second co surgeon

....A small Alexis wound protector was placed throught the anal opening into the distal rectal vault. Sterile glove was applied. The flexible trocars were placed throught the holes of the glove secured with silk ties. CO2 insufflation undertaken to maximum pressure of 10 mmHg. A 5mm, 30 degree laparoscope was utilized for camera visualization. This showed the large rectal polyp anteriorly. This was roughly 8cm from the dentate line. The monopolar cautery was utilized to mark the specimen with 5 to 10mm margin. Specimen was the elevated and excised through the muscularis propria into the perirectal fat. This was carried out circumferentially completley excising the mass. This was retrieved and submitted for pathololgy review. This was marked for orientation.
Glove was returned. the operative site was inspected. It was irrigated with sterile saline. Hemostasis maintained with monopolar cautery. Then 3-0 V-Loc suture was placed inrunning fashion to approximate the mucosal edges.

Give me your thoughts. Thanks!
 
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