CPT® Code 55865

Exposure of prostate, any approach, for insertion of radioactive substance; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes

The CPT® Code 55865 refers to a surgical procedure that involves the exposure of the prostate gland through any approach for the purpose of inserting a radioactive substance, typically used in brachytherapy. This procedure is performed in conjunction with a bilateral pelvic lymphadenectomy, which entails the removal of lymph nodes from both sides of the pelvis, specifically targeting the external iliac, hypogastric, and obturator nodes. The surgical approach may include either a retropubic incision, which is made in the lower abdomen, or a perineal incision. In the case of a retropubic approach, the bladder is carefully displaced to access the area behind the pubic bone, allowing the surgeon to reach the prostate. During the procedure, the physician may utilize a finger guide placed in the rectum to accurately position a hollow applicator needle into the prostate tissue. Once the needle is correctly positioned, radioactive seeds are introduced through the needle and implanted into the prostate. This process involves withdrawing the needle and repositioning it in small increments to place additional seeds, ensuring comprehensive coverage of the target area. The inclusion of a bilateral pelvic lymphadenectomy in this procedure signifies a more extensive surgical intervention, as it involves the removal of all lymph nodes along the obturator fossa, external iliac vein, and hypogastric artery, which is a critical aspect of managing potential cancer spread in the pelvic region.