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Posted By Dorine on 02-23-2018, 18:41:25 in Ob-Gyn
Hello OB/GYN Group,
Pt was prepped for surgery, uterus sounded and cervix dilated, hysteroscope placed, curette used to scrape the endometrial lining, hysterscope replaced visualization was poor and unable to appropriately visualize endometrial lining, scope was removed from the endometrial lining. Plans to perform possibly TLH, it was decided that a VCare uterine manipulator would be placed, and manipulator was placed with some difficulty due to small vaginal canal. Attn was then turned to the abdomen in which laparoscope was placed, it was immediately noted that the patient had extensive pelvic adhesions. The uterus showed a small perforation in the posterior aspect to which the VCare was protruding. The left ovary was unable to be visualized and the left tube and round ligament had extremely distorted anatomy. There was an approximately 6-cm cyst in the anterior left pelvic cul-de-sac with extremely thin membranes with yellow mucus. This cyst was drained and fluid collected, there was also some hemoperitoneum which was evacuated, due to extensive pelvic adhesions and known uterine perforation with VCare, decision was made to convert to laparotomy. Peritoneum was identified; was elevated with hemostats and entered sharply with scissors. VCare perforation was inspected and was noted to have traveled retroperitoneally, a small tag was placed to have general surgery run the bowel to check for additional injuries. A Bookwalter was put in place, remaining cyst fluid was removed and attention turned to the left tubo-ovarian abscess, which was dissected away from the tube in attempt to begin TLH;however due to inflammation, scar tissue and adhesions and distorted anatomy TLH not performed. No bowel injury was noted. Hemostasis was achieved instruments removed. Any help is appreciated. Thank you and have a great weekend!
Comments (2)
Posted By Dorine on 03-01-2018, 10:40:37
Melanie, do you have a suggestion for this surgery code? Thank you.
Posted By Dorine on 02-27-2018, 14:17:15
I wanted to add that the posterior perforation site was closed with O vicryl in a running locking fashion until hemostasis was achieved. Due to high vascularly distorted anatomy and low hemoglobin count (pt refused blood products) add'l could not proceed safely. At that point then all laps and instruments were removed. Hope this additional information helps with correct CPT Coding. Again, thank you in advance.
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