CPT® Code 0336T

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1. Indications

The procedure of laparoscopic surgical ablation of uterine fibroid(s) is indicated for the treatment of benign uterine fibroids, which may cause a variety of symptoms or complications. The following conditions may warrant this procedure:

• Uterine Fibroids - Presence of benign tumors in the uterus that may lead to symptoms such as heavy menstrual bleeding, pelvic pain, or pressure symptoms.
• Submucous Fibroids - Fibroids that protrude into the uterine cavity, potentially causing abnormal bleeding or infertility.
• Intramural Fibroids - Fibroids located within the uterine wall that may contribute to pain or abnormal uterine bleeding.
• Subserous Fibroids - Fibroids that grow on the outer surface of the uterus, which may cause pressure symptoms on surrounding organs.

2. Procedure

The laparoscopic surgical ablation of uterine fibroid(s) involves several key procedural steps, each critical to the successful treatment of the fibroids:

• Step 1: Establishing Access - The procedure begins with the creation of two small incisions: one in the infraumbilical region and another in the suprapubic region. These incisions allow for the insertion of laparoscopic instruments and the establishment of pneumoperitoneum, which is the introduction of carbon dioxide gas into the abdominal cavity to create a working space.
• Step 2: Diagnostic Examination - A diagnostic laparoscopic examination is performed to visualize the internal structures of the abdomen and pelvis. This includes the use of laparoscopic ultrasound to identify the size, number, and location of the uterine fibroids, ensuring that all relevant fibroids are assessed prior to treatment.
• Step 3: Insertion of RFA Device - After the ultrasound evaluation, a small skin incision is made to allow for the percutaneous advancement of the radiofrequency ablation (RFA) device into the peritoneal cavity. This is done under laparoscopic visualization and ultrasound guidance to ensure accurate placement at the site of the fibroid.
• Step 4: Deployment of Electrode Array - The RFA device is equipped with an electrode array that is advanced into the fibroid. The deployment of the electrode array is carefully monitored using ultrasound guidance to ensure proper positioning within the fibroid tissue.
• Step 5: Ablation Process - Once the electrode array is correctly positioned, it is activated, and the temperature of the array is increased to the target level. This temperature is maintained for a prescribed duration to effectively ablate the fibroid tissue, leading to its destruction.
• Step 6: Completion of Procedure - After the ablation of the targeted fibroid(s), the electrode array is deactivated and retracted into the RFA device. If additional fibroids are present, they are treated in the same manner. Once all fibroids have been ablated, the RFA device is removed, and the CO2 gas is allowed to escape from the peritoneal cavity. Finally, the skin incisions are closed.

3. Post-Procedure

Post-procedure care following laparoscopic surgical ablation of uterine fibroid(s) typically involves monitoring for any immediate complications and managing pain. Patients may experience some discomfort or cramping, which can be managed with prescribed pain relief medications. Recovery time can vary, but many patients are able to return to normal activities within a few days. Follow-up appointments are usually scheduled to assess the patient's recovery and to monitor for any recurrence of symptoms or fibroids. It is important for patients to adhere to any specific post-operative instructions provided by their healthcare provider to ensure optimal recovery.