CPT® Code 32671

Thoracoscopy, surgical, with removal of lung (pneumonectomy) is a minimally invasive surgical procedure that involves the use of a thoracoscope, which is a specialized instrument designed for visualizing the thoracic cavity. This procedure is commonly referred to as video-assisted thoracoscopic surgery (VATS). The thoracoscope is inserted through a small incision in the chest wall, typically in the 7th or 8th intercostal space along the mid to anterior axillary line on the affected side. This allows the surgeon to inspect the thoracic structures directly. A larger working incision is then made in the anterolateral chest wall at the 4th intercostal space to facilitate access to the thoracic cavity. Once inside the pleural space, air is injected to create an artificial pneumothorax, which helps to expand the pleural cavity and provides better visualization of the lung and surrounding structures. The surgeon explores the pleura and lung to assess for any signs of metastatic disease and to evaluate whether the lung is resectable. The procedure involves dividing the pleura at the pleural-parenchymal reflection, exploring the hilar structures, and identifying the pulmonary veins, which are then staple ligated to control blood flow. Further dissection of the pleura is performed as necessary, followed by identification and division of the pulmonary arteries. The main bronchus is encircled, stapled, and divided, allowing for the complete mobilization of the lung. An endopouch is introduced to facilitate the removal of the lung through the working incision after it has been placed in the pouch. After the lung is removed, the surgeon controls any bleeding, removes the instruments, places a chest tube to assist with drainage, and finally closes the incisions. This procedure is typically indicated for patients with significant lung disease, such as lung cancer, where the removal of the affected lung is necessary for treatment.