CPT® Code 54840

The procedure described by CPT® Code 54840 involves the excision of a spermatocele, which is a fluid-filled cyst that forms in the epididymis, the coiled tube located at the back of the testis. This surgical intervention may be performed with or without the removal of the epididymis itself, known as an epididymectomy. The patient is positioned supine, meaning they lie on their back, and the scrotum is prepared and draped to maintain a sterile environment. The surgical approach can vary, utilizing either a vertical median raphe incision or a transverse hemiscrotal incision, both of which allow access to the tunica vaginalis, the protective sac surrounding the testis. During the procedure, the testis and epididymis are carefully brought out of the dartos fascia, which is the layer of tissue surrounding the scrotum, using blunt dissection techniques. Alternatively, they may be extracted through a fully incised tunica vaginalis. The surgeon then isolates the spermatocele from the epididymis using both sharp and blunt dissection methods, while also exploring the area for the connecting neck of the spermatocele. If this neck is identified, it is ligated with sutures and subsequently divided. In cases where the neck cannot be found or if the spermatocele is multiloculated, a partial epididymectomy may be necessary, which involves excising a portion of normal epididymal tissue adjacent to the spermatocele. To manage any bleeding that occurs in the epididymal bed, electrocautery is employed. If the spermatocele is particularly large, the tunica vaginalis may be sutured in a radial fashion to reduce the risk of recurrence. Finally, the testis is returned to its original position within the scrotum, and the layers of the tunica vaginalis or dartos are closed, followed by the closure of the skin to complete the procedure.