CPT® Code 57112

Deleted

1. Indications

The procedure described by CPT® Code 57112 is indicated for patients with conditions that necessitate the complete removal of the vaginal wall and surrounding paravaginal tissue, particularly in cases of malignancy. The following are specific indications for this procedure:

• Malignant Tumors Presence of invasive cancer within the vaginal wall or surrounding tissues that requires radical surgical intervention.
• Recurrent Disease Patients with a history of recurrent vaginal cancer that has not responded to previous treatments.
• Pelvic Lymphadenopathy Enlarged lymph nodes in the pelvic region that may indicate metastatic disease.

2. Procedure

The procedure for CPT® Code 57112 involves several critical steps to ensure the complete removal of the vaginal wall and associated tissues. The following outlines the procedural steps:

• Step 1: Midline Abdominal Incision A midline incision is made in the abdomen, extending from the symphysis pubis to just above the umbilicus. This incision allows access to the abdominal cavity for exploration and assessment of any potential pelvic metastases.
• Step 2: Exploration of the Abdomen The abdomen is explored to determine the presence of pelvic metastases. This step is crucial for staging the cancer and planning the extent of the surgery.
• Step 3: Exposure of Pelvic Lymph Nodes The pelvic lymph nodes are carefully exposed. This includes identifying and dissecting the external and common iliac nodes, hypogastric nodes, and/or obturator nodes, which may be involved in the disease process.
• Step 4: Dissection and Removal of Involved Lymph Nodes Any lymph nodes that are found to be involved with cancer are meticulously dissected free from surrounding tissues and removed. This step is essential for ensuring that all cancerous tissues are excised.
• Step 5: Para-Aortic Lymph Node Sampling The para-aortic lymph nodes are exposed, and frozen sections are sent for pathology examination to assess for malignancy. This sampling is critical for determining the extent of disease spread.
• Step 6: Removal of Vaginal Wall and Paravaginal Tissue The vaginal wall and paravaginal tissue are removed as previously described, ensuring complete excision of the affected areas.

3. Post-Procedure

After the completion of the procedure, patients will require careful monitoring and post-operative care. This includes managing pain, monitoring for any signs of infection, and ensuring proper healing of the surgical site. Patients may also need follow-up appointments for pathology results and further treatment planning based on the findings from the lymph node sampling. Rehabilitation and counseling may be necessary to address any physical or emotional impacts resulting from the surgery.