CPT® Code 56640

The procedure described by CPT® Code 56640 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 and glands, 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 extends deeper into the perineal fascia and may reach the periosteum of the pubic symphysis, ensuring that all affected vulvar structures are excised. The surgical approach requires careful planning, including marking excision margins to include healthy tissue surrounding the malignancy. 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 continuing to the perineal fascia and potentially into the pubic symphysis. This procedure is often accompanied by inguinofemoral, iliac, and pelvic lymphadenectomy, which involves the removal of lymph nodes in these regions to assess and manage potential metastasis. The complexity of this surgery necessitates meticulous technique to minimize complications and ensure thorough removal of cancerous tissues.