CPT® Code 55881

1. Indications

The procedure described by CPT® Code 55881 is indicated for the treatment of malignant prostate tissue. It is specifically utilized in cases where there is a need to ablate cancerous cells within the prostate gland, thereby reducing tumor size and potentially improving patient prognosis. The use of MRI guidance enhances the precision of the procedure, making it suitable for patients with specific anatomical considerations or those who may benefit from a targeted approach to prostate cancer treatment.

• Malignant Prostate Tissue The primary indication for this procedure is the presence of cancerous tissue within the prostate gland that requires ablation to manage the disease effectively.

2. Procedure

The procedure begins with the placement of the TULSA transducer and an endorectal cooling tube, which are positioned within the patient's body to facilitate the ablation process. The physician, typically a urologist, ensures that these devices are functioning correctly before proceeding. Following this, an MRI surface coil is placed over the pelvis to assist in imaging. An initial MRI scan is conducted to check for any air bubbles in the rectum that could interfere with the cooling mechanism and to confirm the correct positioning of the transducer and cooling device. Once the imaging is complete, treatment images are sent to a planning software workstation, where a detailed treatment plan is generated. This plan takes into account any calcifications identified between the transducer elements, which are adjusted to minimize impedance to the ablative energy. The treating physician then utilizes the MRI-compatible robotic positioning system to advance the ablation transducer to the designated treatment zone. The physician determines the direction and rotational angle of the ultrasound applicator to ensure that the prescribed volume of target tissue is effectively ablated. Prior to initiating the ablation, an anti-spasmodic drug is administered to the patient to facilitate the procedure. The closed-loop MRI-guided ultrasound ablation treatment then commences, with the transducer emitting ultrasound energy while rotating to achieve optimal ablative temperatures. Throughout the procedure, MRI images are continuously acquired and displayed, allowing the physician to monitor the delivery of ablative energy in real-time. If necessary, treatment may be paused, or adjustments to the ultrasound transducer can be made based on thermal feedback. Should there be any need to change the position of the patient or the transducer, the treatment must be halted, allowing the tissues to cool before resuming with a new set of MRI images and an updated treatment plan. Finally, contrast-enhanced images are obtained immediately after the treatment to confirm that satisfactory ablation of the target tissue has been achieved.

• Step 1: Placement of the TULSA transducer and endorectal cooling tube, ensuring proper function.
• Step 2: Application of an MRI surface coil and initial MRI scanning to confirm positioning and check for air bubbles.
• Step 3: Generation of a detailed treatment plan using imaging data to avoid critical tissues and optimize thermometry.
• Step 4: Advancement of the ablation transducer using a robotic positioning system, determining the direction and angle for ablation.
• Step 5: Administration of an anti-spasmodic drug followed by the initiation of the closed-loop MRI-guided ultrasound ablation treatment.
• Step 6: Continuous monitoring of ablative energy delivery through real-time MRI imaging, with adjustments made as necessary.
• Step 7: Acquisition of contrast-enhanced images post-treatment to confirm satisfactory ablation.

3. Post-Procedure

After the completion of the ablation procedure, patients are typically monitored for any immediate complications or side effects. The use of MRI guidance allows for precise confirmation of successful ablation, which is crucial for assessing treatment efficacy. Patients may experience some discomfort or mild side effects, which should be managed according to standard post-procedural care protocols. Follow-up imaging may be scheduled to evaluate the long-term effectiveness of the treatment and to monitor for any recurrence of malignant tissue. It is essential for healthcare providers to provide patients with clear instructions regarding recovery, including any activity restrictions and signs of potential complications that should prompt immediate medical attention.