CPT® Code 58260

The CPT® Code 58260 refers to a surgical procedure known as a vaginal hysterectomy, specifically performed on a uterus that weighs 250 grams or less. In this procedure, the physician accesses the uterus through the vaginal canal, which is a less invasive approach compared to abdominal hysterectomy techniques. The process begins with the placement of tenacula, which are surgical instruments used to grasp the cervix, allowing for better visibility and access to the surrounding structures. The vaginal mucosa, which is the lining of the vagina, is then incised around the cervix to facilitate the removal of the uterus. Following the incision, traction is applied to the tenacula to stabilize the cervix while the bladder is carefully separated from the uterus using both blunt and sharp dissection techniques. This step is crucial to avoid injury to the bladder during the procedure. Once the bladder is elevated, the peritoneal vesicouterine fold is incised, allowing access to the cul-de-sac, which is the space behind the uterus. The broad ligament, which supports the uterus, is then exposed, and the uterosacral ligaments are clamped and divided to further free the uterus. The cardinal ligaments, which provide additional support to the uterus, are clamped at the lower uterine segment, incised, and ligated with sutures to prevent bleeding. The lower portion of the broad ligament is also clamped and divided at its attachment to the lower uterine segment. After these steps, the posterior wall of the uterus is grasped, and the uterus is delivered into the vagina. If the procedure involves the removal of the fallopian tubes and ovaries, the tubo-ovarian round ligaments are exposed, clamped, and incised close to the uterine fundus on both sides. The fallopian tubes are then transected, and the round ligaments are doubly ligated. The uterus is subsequently removed, and if the tubes and ovaries are also to be excised, the round ligament is cut and tied bilaterally. Tension is applied to the infundibulopelvic ligament, which is then cut, allowing for the delivery of the tubes and ovaries along with the uterus into the vaginal canal. After the removal of these structures, the anterior vaginal wall is elevated, and the entire length of the broad ligament is inspected to control any bleeding. The peritoneum is then closed, and the vaginal cuff is intentionally left open to allow for drainage of the pelvis. It is important to note that this code is specifically used when only the uterus is removed, while different codes apply when additional structures such as the tubes and ovaries are also excised or when an enterocele repair is performed.