CPT® Code 55680

1. Indications

The excision of a Mullerian duct cyst, coded as CPT® 55680, is indicated for the treatment of specific conditions associated with the presence of these cysts. The following are the primary indications for performing this procedure:

• Congenital Anomaly The presence of a Mullerian duct cyst, which is a rare congenital anomaly in males, necessitating surgical intervention to prevent complications.
• Symptoms of Discomfort Patients may experience discomfort or pain due to the cyst's location and size, prompting the need for excision.
• Potential for Infection There is a risk of infection associated with the cyst, which may warrant surgical removal to mitigate this risk.
• Urinary Obstruction Although these cysts do not communicate with the urethra, their size or location may lead to urinary obstruction, necessitating excision.

2. Procedure

The procedure for excising a Mullerian duct cyst involves several critical steps, each designed to ensure the safe and effective removal of the cyst. The following outlines the procedural steps:

• Step 1: Suprapubic Approach The surgeon begins by making a suprapubic incision in the abdomen, which provides access to the area behind the bladder. This approach is chosen to minimize trauma to surrounding structures and facilitate a clear view of the surgical field.
• Step 2: Opening the Peritoneum After the abdominal incision, the peritoneum is carefully opened to expose the underlying structures. This step is crucial for accessing the prostate gland and the prostatic utricle, which are located in close proximity to the cyst.
• Step 3: Identification of Structures The surgeon identifies the prostate gland and the prostatic utricle, which are essential landmarks during the procedure. Careful dissection is performed to avoid damaging these structures while locating the cyst.
• Step 4: Incision and Identification of the Cyst The area surrounding the cyst is incised until the Mullerian duct and the cyst are clearly identified. This step requires precision to ensure that the cyst is fully visualized for successful excision.
• Step 5: Ligation of the Cyst Neck Once the cyst is identified, the neck of the cyst is ligated. This step is critical to prevent any leakage of cyst contents during the excision process.
• Step 6: Excision of the Cyst The cyst is then excised from its attachment to the verumontanum. This step must be performed with care to ensure complete removal of the cyst and to minimize the risk of recurrence.
• Step 7: Closure of the Peritoneum After the cyst has been successfully removed, the peritoneum is closed to restore the integrity of the abdominal cavity.
• Step 8: Closure of the Abdominal Incision Finally, the abdominal incision is closed in layers, ensuring proper healing and reducing the risk of complications such as infection or hernia formation.

3. Post-Procedure

Post-procedure care following the excision of a Mullerian duct cyst involves monitoring the patient for any signs of complications, such as infection or excessive bleeding. Patients are typically advised to rest and may be prescribed pain management medications to alleviate discomfort. Follow-up appointments are essential to assess the surgical site and ensure proper healing. Patients should be informed about signs of potential complications, such as fever, increased pain, or unusual discharge from the incision site, and instructed to seek medical attention if these occur. Overall, the expected recovery period may vary depending on individual patient factors, but most patients can anticipate a gradual return to normal activities within a few weeks following the procedure.