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Thread: biopsy of cyst wall during cholecystectomy

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    Join Date
    Apr 2007

    Default biopsy of cyst wall during cholecystectomy

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    Patient had a laparoscopic cholecystectomy and with this also had a cyst fenestration with biopsy of cyst wall .is this consider bundled ?If not, I cant seem to find the code for the cyst of liver. ,here is operative report , if anyone has any suggestions

    OPERATIONS: 1. Single-incision laparoscopic cholecystectomy. 2. Cyst fenestration. 3. Biopsy of a cyst wall.
    , M.D.
    ANESTHESIA: General.
    BLOOD LOSS: None.
    The patient was taken to the OR and prepped and draped in the usual sterile fashion in lithotomy position after antibiotics were given. 6 cc of 0.25% Marcaine were infiltrated into the 7 o'clock and 2 o'clock position on the umbilicus. An incision was made with a #11 scalpel. A 5 mm optical trocar was then inserted into the abdomen under direct visualization allowing pneumoperitoneum to be established. Once this was done, a second 5 mm trocar was placed in the 2 o'clock position. We scanned the liver. There were multiple simple cysts on the surface of the liver. Three of these were unroofed, one over segment #4 area and two on the right lobe of the liver. We did a biopsy of the cyst wall on the segment #4 area and sent it for permanent section. We were able to place a 0-silk on the straight needle in the right upper quadrant, grasping the gallbladder, elevating up to the abdominal wall and tying allowing us to do retraction. We were then able to place another needle through the epigastric area through the infundibulum of the gallbladder and out through the right upper quadrant allowing us lateral retraction of the gallbladder. We were able to dissect free the cyst duct-gallbladder junction, and we were able to adequately visualize the cystic duct entering the gallbladder. We transected this with the Harmonic scalpel, as we did also the cystic artery. We were able to elevate the gallbladder off of the gallbladder fossa using the Harmonic scalpel. There was excellent hemostasis. We did also suction out the cyst. Once all of this was done, we recognized we had excellent hemostasis. We were able to grasp the gallbladder. There were no signs of any biliary leakage and I removed the gallbladder through the umbilicus. We connected the two incisions that we had made at the 2 o'clock and 7 o'clock position, using a scalpel and electrocautery. Gallbladder came out easily.

    The fascial defects were repaired using 0-Vicryl and the skin was closed using 4-0 running subcuticular stitch. All needle and sponge counts were correct.

    _____________________________________ ______________
    Last edited by codedog; 02-08-2011 at 08:56 AM.

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