CPT® Code 58267

1. Indications

The procedure described by CPT® Code 58267 is indicated for patients presenting with conditions that necessitate a vaginal hysterectomy, particularly when the uterus is 250 grams or less. The specific indications for this procedure may include:

• Uterine Fibroids - Noncancerous growths in the uterus that can cause pain, heavy bleeding, or other complications.
• Uterine Prolapse - A condition where the uterus descends into the vaginal canal, often requiring surgical intervention for correction.
• Abnormal Uterine Bleeding - Heavy or irregular menstrual bleeding that does not respond to conservative treatments.
• Endometriosis - A condition where tissue similar to the lining inside the uterus grows outside of it, leading to pain and other symptoms.
• Chronic Pelvic Pain - Persistent pain in the lower abdomen that may be related to uterine conditions.

2. Procedure

The procedure for CPT® Code 58267 involves several critical steps, each performed with precision to ensure successful outcomes. The steps are as follows:

• Step 1: Cervical Grasping - Tenacula are placed on the cervix to provide traction, allowing for better access to the surgical site.
• Step 2: Incision of Vaginal Mucosa - The vaginal mucosa is incised around the entire cervix, creating an opening for further dissection.
• Step 3: Bladder Separation - Blunt and sharp dissection techniques are employed to separate the bladder from the uterus, ensuring that the bladder is elevated to expose the peritoneal vesicouterine fold.
• Step 4: Peritoneal Incision - The peritoneal vesicouterine fold is incised, followed by an incision of the cul-de-sac to expose the peritoneum.
• Step 5: Broad Ligament Exposure - The broad ligament is exposed, allowing access to the uterine support structures.
• Step 6: Ligament Clamping and Division - The uterosacral ligaments are clamped and divided, followed by clamping, incising, and suture ligating the cardinal ligaments at the lower uterine segment.
• Step 7: Broad Ligament Division - The lower portion of the broad ligament is clamped and divided at its attachment to the lower uterine segment.
• Step 8: Uterine Delivery - The posterior uterine wall is grasped, and the uterus is delivered into the vagina for removal.
• Step 9: Tubo-Ovarian Ligament Management - The tubo-ovarian round ligaments are exposed, clamped, and incised close to the uterine fundus bilaterally, followed by transection of the fallopian tubes.
• Step 10: Uterus Removal - The uterus is completely removed, and the fallopian tubes are returned to the abdominal cavity.
• Step 11: Colpo-Urethrocystopexy - The colpo-urethrocystopexy is performed to suspend the prolapsed vaginal wall and urethra, involving the placement of sutures through the paravaginal fascia and tying them to provide support.
• Step 12: Surgical Site Inspection - The surgical site is inspected for any bleeding, which is controlled as necessary.
• Step 13: Closure - The peritoneum is closed, and the vaginal cuff is left open to allow for drainage of the pelvis.

3. Post-Procedure

Post-procedure care following a vaginal hysterectomy with colpo-urethrocystopexy includes monitoring for any signs of complications such as bleeding or infection. Patients are typically advised to rest and avoid strenuous activities for a specified period to promote healing. Follow-up appointments are essential to assess recovery and ensure that the surgical site is healing properly. Patients may also receive instructions regarding pain management and activity restrictions to facilitate a smooth recovery process.