CPT® Code 58571

A total laparoscopic hysterectomy (TLH) is a minimally invasive surgical procedure aimed at removing the uterus, which in this case weighs 250 grams or less. This procedure is typically performed through the vagina while keeping the uterus intact. The process begins with the insertion of a urinary catheter into the bladder via the urethra to facilitate the surgery. Following this, the cervix is dilated, and a uterine sound is utilized to measure the length of the uterus, ensuring accurate surgical planning. A uterine manipulator is then placed transvaginally through the cervix to assist in maneuvering 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 allows for visualization of the abdominal cavity, and the abdomen is insufflated with gas to create a working space. Additional incisions are made suprapubically 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 dissection of the bladder away 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. 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, and the pneumoperitoneum is allowed to escape. The uterus and cervix are then delivered into the vagina and removed. If applicable, the procedure also includes the delivery and removal of the tube(s) and/or ovary(s) along with the uterus. After the removal, the occlusion device is replaced, and the abdomen is reinflated to complete the procedure. Finally, the vagina is closed using laparoscopic suturing techniques at the apex, which is further supported with sutures in the uterosacral ligaments to prevent potential vaginal prolapse.