CPT® Code 58570

A total laparoscopic hysterectomy (TLH) is a minimally invasive surgical procedure aimed at the complete removal of the uterus, specifically when it weighs 250 grams or less. This procedure is typically performed through the vagina while keeping the uterus intact, which allows for a more efficient recovery and less postoperative pain compared to traditional open surgeries. The process begins with the insertion of a urinary catheter into the bladder via the urethra to ensure the bladder is empty during the operation. Following this, the cervix is dilated, and a uterine sound is utilized to measure the length of the uterus, which aids in the surgical planning. A uterine manipulator is then placed transvaginally through the cervix to facilitate the maneuvering of the uterus during the procedure. To maintain the integrity of the surgical field, a vaginal extender, also known as a cervical cup, is positioned, and an occlusion device is inserted to prevent the loss of air from the peritoneal cavity. The surgeon makes an incision below the umbilicus to insert a laparoscope, which is a specialized camera that allows for visualization of the abdominal cavity. The abdomen is insufflated with gas to create a working space for the surgery. Additional incisions are made in the suprapubic area and bilaterally near the hip bones to accommodate other surgical instruments necessary for the procedure. During the surgery, the ureters are carefully identified and protected to prevent injury. The peritoneum covering the bladder is incised, allowing for the dissection of the bladder from the lower uterine segment, thereby exposing the anterior vagina. An incision is made into the anterior aspect of the vagina, which is then extended laterally and posteriorly while preserving the uterosacral ligament to maintain pelvic support. The utero-ovarian ligament, along with the uterine attachments and associated blood vessels, are divided to facilitate the removal of the uterus. The patient is positioned in high lithotomy to optimize access to the surgical site, and the pneumoperitoneum is allowed to escape. The uterus and cervix are then delivered into the vagina and removed. After the uterus is excised, the occlusion device is replaced, and the abdomen is reinflated to ensure a clear surgical field for closure. Finally, the vagina is closed using laparoscopic suturing techniques at the apex, which are reinforced with sutures in the uterosacral ligaments to prevent future vaginal prolapse. This procedure is coded under CPT® Code 58570, and if the tubes and/or ovaries are also removed, CPT® Code 58571 should be used.