CPT® Code 56634

The procedure described by CPT® Code 56634 refers to a radical vulvectomy, which is a surgical operation involving the complete removal of the vulva, including the mons pubis, labia majora and minora, clitoris, vaginal vestibule, urethral opening, and vaginal opening. This extensive procedure is primarily indicated for the treatment of invasive carcinoma affecting the vulvar region. Unlike a simple vulvectomy, which involves the removal of less tissue, a radical vulvectomy entails excising not only the vulvar structures but also extending the incision into the perineal fascia and potentially reaching the periosteum of the pubic symphysis. The surgical approach requires careful planning to ensure that excision margins are adequate, incorporating healthy tissue around the tumor to minimize the risk of residual cancerous cells. The incision typically begins above the labial folds in the mons pubis and proceeds through various layers of tissue, including the skin and subcutaneous fat, with deep dissection to ensure complete removal of affected areas. Additionally, this procedure is often accompanied by a unilateral inguinofemoral lymphadenectomy, which involves the removal of lymph nodes in the groin area to assess and manage potential metastasis. The combination of these surgical interventions is critical in the comprehensive treatment of vulvar cancer, aiming to achieve clear margins and prevent the spread of malignancy.