CPT® Code 47122

The procedure described by CPT® Code 47122 refers to a hepatectomy, specifically a trisegmentectomy, which involves the surgical resection of significant portions of the liver. In this operation, the physician removes the entire right lobe of the liver, along with the medial segment of the left lobe, and the hepatic parenchyma located to the right of the falciform ligament and the ligamentum teres. This extensive resection is also known as a right extended lobectomy. The procedure is typically performed through an incision made in the right subcostal region, which may extend into the left subcostal region or even cranially over the xiphoid process, allowing for adequate access to the liver. During the surgery, the right rectus muscle is transected, and the oblique muscles are split to facilitate access. The medial portion of the left rectus muscle is also transected to mobilize the right lobe of the liver toward the left side. Critical structures such as the cystic artery and duct are ligated and divided to prevent bleeding. The peritoneum is incised to expose the right main hepatic artery, which is carefully identified and protected throughout the procedure. The dissection continues superiorly and posteriorly, with particular attention to safeguarding the portal vein. The right main hepatic duct is then dissected free, and the hepatic vein is located and transected. The liver capsule is incised, and the parenchyma is transected, which may alternatively involve transecting the hepatic parenchyma in the interlobar plane. An incision is made to the right of the falciform ligament, allowing for access to the umbilical fissure, where vessels and ducts leading to the medial segment of the left lobe are divided, while preserving those to the lateral segment. Finally, the three segments are devascularized and excised, and the incision is closed over drains after ensuring that any bleeding is controlled and the wound is properly irrigated.