CPT® Code 58292

1. Indications

The procedure described by CPT® Code 58292 is indicated for the following conditions:

• Enlarged Uterus - The primary indication for this procedure is the presence of an enlarged uterus, typically weighing more than 250 grams, which may cause discomfort or other complications.
• Pelvic Organ Prolapse - The repair of an enterocele, which is a type of pelvic organ prolapse, is also a significant indication for this procedure, as it addresses the herniation of pelvic organs.

2. Procedure

The surgical procedure for CPT® Code 58292 involves several detailed steps to ensure the effective removal of the uterus and associated structures:

• Preparation and Initial Incision - The procedure begins with the placement of tenacula on the cervix to provide traction. The vaginal mucosa is then incised around the entire cervix to gain access to the uterus.
• Separation of Bladder and Uterus - Blunt and sharp dissection techniques are employed to separate the bladder from the uterus. The bladder is elevated to expose the peritoneal vesicouterine fold, which is subsequently incised to facilitate further dissection.
• Accessing the Cul-de-Sac - The cul-de-sac is exposed, and the peritoneum is incised to allow access to the uterine vessels, which are then ligated to control blood flow.
• Morcellation of the Uterus - One of the morcellation techniques, such as hemisection, intramyometrial coring, or wedge resection, is utilized to remove the uterus in manageable pieces as the uterine attachments are severed.
• Division of Ligaments - The uterosacral ligaments are clamped and divided, followed by the clamping, incising, and suture ligation of the cardinal ligaments at the lower uterine segment.
• Removal of Tubes and Ovaries - The lower portion of the broad ligament is clamped and divided, and the tubo-ovarian round ligaments are exposed, clamped, and incised close to the uterine fundus bilaterally. The fallopian tubes are transected, and the round ligaments are doubly ligated before the entire uterus is removed.
• Alternative Removal of Tubes and Ovaries - If the tubes and ovaries are to be removed, the round ligament is cut and tied bilaterally, and tension is applied to the infundibulopelvic ligament, which is then cut to allow for the delivery of the tubes and ovaries along with the morcellized uterus.
• Closure of the Surgical Site - The anterior vaginal wall is elevated, and the entire length of the broad ligament is exposed to control any bleeding. The peritoneum is then closed, and the vaginal cuff is left open to allow for drainage of the pelvis.

3. Post-Procedure

Post-procedure care for patients undergoing CPT® Code 58292 includes monitoring for any complications related to the surgery, such as bleeding or infection. Patients are typically advised to follow up with their healthcare provider to assess recovery and ensure proper healing. The vaginal cuff is intentionally left open to facilitate drainage, which is an important consideration in the post-operative management of the patient. Patients may also receive instructions regarding activity restrictions and signs of complications to watch for during their recovery period.