CPT® Code 49188

1. Indications

The procedure is indicated for the excision or destruction of intra-abdominal tumors or cysts, which may present as either primary or secondary malignancies. The specific indications for performing this procedure include:

• Primary Tumors Tumors that originate in the abdominal cavity.
• Secondary Tumors Tumors that have metastasized to the abdominal cavity from other sites in the body.
• Cysts Fluid-filled sacs that may require removal due to size or associated symptoms.

2. Procedure

The procedure involves several critical steps to ensure the effective excision or destruction of the tumors or cysts:

• Step 1: An incision is made in the abdomen, extending to the level of the peritoneum. The peritoneum is carefully grasped, elevated, and incised to gain access to the abdominal cavity.
• Step 2: Once the peritoneal cavity is opened, any adhesions are dissected to expose the abdominal viscera. This step is crucial for visualizing the entire abdominal cavity.
• Step 3: The surgeon performs a thorough exploration of the abdominal cavity, using both visual inspection and palpation to identify all masses and abnormalities present.
• Step 4: A self-retaining retractor is placed to maintain exposure of the surgical field. The location, size, and extent of the primary mass are documented, and surrounding tissues are carefully packed to enhance visibility.
• Step 5: The tumor is either meticulously resected or destroyed using electrocautery or laser techniques. This process is repeated for all tumors until complete excision or destruction is achieved.
• Step 6: For retroperitoneal tumors, similar techniques are employed, with particular care taken to avoid injury to the kidneys, ureters, and renal vessels.
• Step 7: After the tumors have been addressed, the abdominal cavity is irrigated with an antibiotic solution and inspected for any potential injuries before the removal of instruments.
• Step 8: The organs are returned to their proper anatomical positions, and the omentum is replaced over the abdominal contents. Drains may be placed as necessary before closing the fascia and other soft tissues.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications that may arise from the surgery. Expected recovery includes managing pain and ensuring proper healing of the incision site. The surgical team will assess the patient for any signs of infection or other postoperative issues. Follow-up appointments are essential to evaluate the success of the procedure and to monitor for any recurrence of tumors or cysts. The placement of drains, if utilized, will also require care and monitoring to prevent complications.