CPT® Code 58553

The procedure described by CPT® Code 58553 refers to a laparoscopic surgical technique that involves performing a vaginal hysterectomy on a uterus that weighs more than 250 grams. This minimally invasive approach begins with the creation of a small incision just below the umbilicus, through which a trocar is inserted to allow for the introduction of a laparoscope. The laparoscope is a specialized instrument equipped with a camera that provides visual access to the abdominal cavity and the uterus, enabling the surgeon to inspect these areas thoroughly. To facilitate the surgical procedure, two or three additional portal incisions are made in the lower abdomen for the insertion of various surgical instruments. During the operation, bipolar coagulation is utilized to manage bleeding effectively. The surgeon transects the round ligaments and subsequently the broad ligament, which are essential structures supporting the uterus. To elevate the vaginal apex, ring forceps are employed while the bladder flap is developed through both blunt and sharp dissection techniques. The procedure continues with the coagulation and transection of the bladder pillars, followed by the development of the perivesical and perivaginal spaces, again using both blunt and sharp dissection methods. A linear stapler is then used to transect either the infundibulopelvic or utero-ovarian ligaments, depending on whether the surgical plan includes the removal of the fallopian tubes and/or ovaries. The ascending branch of the uterine artery is also transected to ensure proper blood flow management. A circular incision is made in the upper aspect of the vaginal wall to access the cardinal ligament, which is approached vaginally, cross-clamped, divided, and ligated with sutures. The uterus is then delivered through the vaginal incision and removed. If necessary, techniques such as wedge morcellation, coring, or bivalving may be employed to facilitate the removal of the uterus. Finally, the peritoneum and vaginal cuff are closed, and the abdomen is inspected laparoscopically to ensure there is no residual bleeding, which is controlled using laser cautery if needed. The abdomen is irrigated, instruments are removed, and the portal incisions are closed. It is important to note that this code is specifically used for laparoscopic-assisted vaginal hysterectomy (LAVH) without the removal of tubes and/or ovaries, while a different code (CPT® Code 58554) is designated for cases where the tubes and/or ovaries are removed.