CPT® Code 32445

The CPT® Code 32445 refers to the surgical procedure known as an extrapleural pneumonectomy, which involves the removal of a lung along with associated structures such as the parietal pleura, pericardium, and a portion of the diaphragm. This complex procedure is typically indicated for patients with severe lung disease or malignancies that necessitate the removal of not only the lung but also surrounding tissues to ensure complete excision of the affected area. The surgery is performed through a posterolateral thoracic incision, which allows the surgeon to access the thoracic cavity effectively. During the procedure, the lung is deflated, and major blood vessels are carefully ligated and divided to prevent excessive bleeding. The main bronchus is then clamped and incised, allowing for the removal of the lung. The meticulous dissection of the tissue surrounding the lung is crucial, as it is essential to avoid entering the pleural cavity. After the lung and parietal pleura are excised, any involved portions of the pericardium are also removed and typically replaced with a synthetic patch to maintain structural integrity. Additionally, a portion of the diaphragm may be excised and similarly replaced. The remaining bronchus is then closed using staples or sutures, ensuring that the airway is properly sealed post-surgery. This procedure is significant in the management of certain thoracic conditions and requires a high level of surgical expertise due to its complexity and the critical structures involved.