CPT® Code 58294

The procedure described by CPT® Code 58294 involves a vaginal hysterectomy performed on a uterus that weighs more than 250 grams, accompanied by the repair of an enterocele. A vaginal hysterectomy is a surgical procedure in which the uterus is removed through the vaginal canal. In cases where the uterus is significantly enlarged, weighing over 250 grams, the removal process may necessitate morcellization, which is the division of the uterus into smaller pieces to facilitate extraction. This can be achieved through various techniques such as hemisection, where the uterus is cut into two halves; intramyometrial coring, which involves removing a core of tissue from the uterus; or wedge resection, which entails cutting the uterus into multiple segments. During the procedure, tenacula, which are surgical instruments used to grasp tissue, are placed on the cervix to provide traction. The vaginal mucosa is incised around the cervix to access the uterus. The surgeon then separates the bladder from the uterus using both blunt and sharp dissection techniques. This step is crucial for ensuring that the bladder is not damaged during the hysterectomy. The peritoneal vesicouterine fold is incised to further expose the surgical area, followed by the incision of the cul-de-sac and peritoneum. The uterine vessels are ligated to prevent excessive bleeding during the procedure. Once the uterus is prepared for removal, one of the morcellization techniques is employed to facilitate the extraction of the uterus while severing its attachments. The procedure continues with the clamping and division of the uterosacral and cardinal ligaments, which support the uterus. If the ovaries and fallopian tubes are also to be removed, additional steps are taken to ligate and transect these structures. After the morcellized uterus is completely removed, the anterior vaginal wall is elevated, and any bleeding is controlled. The peritoneum is then closed, and the vaginal cuff is intentionally left open to allow for drainage of the pelvis. The repair of the enterocele involves opening the vaginal mucosa over the enterocele, dissecting the perirectal fascia, and managing the enterocele sac to ensure that the small bowel is repositioned correctly within the abdomen. The enterocele sac is then closed with purse-string sutures, and any redundant tissue is excised, completing the procedure.