CPT® Code 58552

The procedure described by CPT® Code 58552 involves a laparoscopically assisted vaginal hysterectomy (LAVH) performed on a uterus that weighs 250 grams or less. This surgical technique combines the use of laparoscopic instruments with traditional vaginal surgery to remove the uterus, and it may also include the removal of one or both fallopian tubes and/or ovaries. The procedure begins with the creation of a small incision below the umbilicus, through which a trocar is inserted to allow for the introduction of a laparoscope. This instrument provides the surgeon with a visual guide to inspect the abdominal cavity and the uterus. Additional small incisions are made in the lower abdomen to facilitate the insertion of surgical instruments necessary for the operation. During the procedure, the surgeon employs bipolar coagulation to manage bleeding while transecting the round ligaments and broad ligament. The vaginal apex is elevated using ring forceps, and the bladder flap is developed through careful dissection. The procedure continues with the coagulation and transection of the bladder pillars, followed by the development of the perivesical and perivaginal spaces. A linear stapler is utilized to transect the infundibulopelvic or utero-ovarian ligaments, depending on whether the tubes and/or ovaries are being excised. The ascending branch of the uterine artery is also transected, and an incision is made in the upper aspect of the vaginal wall. The cardinal ligament is accessed vaginally, clamped, divided, and ligated with sutures. The uterus is then delivered through the vaginal incision and removed, after which the vaginal cuff is closed. The laparoscopic inspection of the abdomen is performed to ensure there is no bleeding, which is controlled if necessary using laser cautery. Finally, the abdomen is irrigated, instruments are withdrawn, and the portal incisions are closed. This procedure is distinct from CPT® Code 58550, which is used when the LAVH is performed without the removal of tubes and/or ovaries.