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Posted By Dorine on 11-20-2020, 14:44:27 in Ob-Gyn
Hello Group, my doctor did a Joel-Cohen incision technique after the attempt was done laparoscopically-here is a portion of the condensed op report: Laparoscope confirmed for placement, uterus elevated from pelvis w/ sponge stick, both ovaries and tubes visualized, the right ovary de-torsed. The IP ligament was identified and isolated. A ligasure device was then used to coagulate and cut the IP ligament. This was followed by transection of right fallopian tube. The mass was detached at this time. An 11 mm trocar was now introduced through the umbilical port to attempt mass removal. An endocatch bag was introduced but unsuccessful due to size of mass. Therefore, the decision was made to proceed with a mini laparotomy. Pneumoperitoneum was released, and correct instrument counts confirmed. A Joel-Cohen incision was made and carried down through the subcutaneous tissue to the fasica. Fascial incision was made and extended laterally. The fascia was separated from the underlying rectus tissue superiorly and inferiorly. The peritoneum was identified and entered. The mass was appreciated at this time with manual palpation and removal w/o difficulty. Facial layer closed in running fashion w/ O Vicryl. A 2-0 vicryl was used to close the subcutaneous skin, the skin was closed w/ a suture in a subcuticular fashion w/ 4-0 monocryl. The 11mm port fascia was closed w/ an 0-vicrly. Remainder of skin incisions were closed w/ 4-0 Monocryl suture. Instrument, sponge, and needle count were correct prior to the abdominal closure. My question is, since this is a mini laparotomy should I use the laparoscopic code (58661) or the laparotomy code (58720). Just wondering how much of a difference the Joel_Cohen vs the pfannenstiel was since they did the Joel-Cohen approach. Thank you for your assistance!