CPT® Code 58672

1. Indications

The laparoscopic fimbrioplasty is performed for specific conditions affecting the fimbriae and fallopian tubes. The following indications are explicitly recognized for this procedure:

• Agglutination or Clubbing of the Fimbriae - This condition occurs when the fimbriae become fused or malformed, which can hinder the transport of the egg from the ovary to the uterus.
• Filmy Adhesions - These are thin bands of scar tissue that can form between organs in the pelvic cavity, potentially obstructing the normal function of the fallopian tubes.
• Hydrosalpinx - This condition involves the accumulation of fluid in the fallopian tube, which can occur without complete closure of the ostium, leading to infertility issues.

2. Procedure

The laparoscopic fimbrioplasty involves several detailed procedural steps to ensure effective treatment of the identified conditions. The following steps outline the process:

• Step 1: Incision and Trocar Placement - The procedure begins with the surgeon making a small incision just below the umbilicus. A trocar is then inserted through this incision to provide access to the abdominal cavity.
• Step 2: Establishing Pneumoperitoneum - Once the trocar is in place, pneumoperitoneum is established by inflating the abdominal cavity with air. This inflation allows for better visualization of the internal structures during the procedure.
• Step 3: Visual Inspection - The surgeon uses the laparoscope to visually inspect the abdominal cavity, including the uterus, fallopian tubes, and ovaries, to identify any abnormalities that require intervention.
• Step 4: Additional Incisions - To facilitate the introduction of surgical instruments, two or three additional portal incisions are made in the lower abdomen.
• Step 5: Distension of the Fallopian Tube - The fallopian tube may be distended by injecting indigo carbine solution through a cannula that is placed vaginally into the uterus. This step helps in identifying blockages within the tube.
• Step 6: Lysis of Adhesions - Any adhesions surrounding the fallopian tube, ovary, and round ligament are lysed to free the structures and restore normal anatomy.
• Step 7: Opening the Clubbed End of the Tube - The clubbed end of the fallopian tube is opened using electrocautery, allowing for better access to the fimbriae.
• Step 8: Elevation of the Serosal Layer - Microforceps are utilized to elevate the serosal layer that lies over the end of the tube, ensuring that the fimbriae can be adequately accessed.
• Step 9: Exposure of the Fimbriae - The tube is opened sufficiently to allow the indigo carbine solution to spill out. Microforceps are then used to pick up the scarred serosal tissue, which is transected to expose the fimbriae.
• Step 10: Prolapse of the Fimbriae - The scarred serosal tissue is folded back, allowing the fimbriae to prolapse out of the tube for better visibility and access.
• Step 11: Separation of the Fimbriae - The fimbriae are separated by irrigation with warm saline solution, which helps to clear any remaining debris and improve their function.
• Step 12: Suturing the Serosal Tissue - The scarred serosal tissue is sutured to the exterior serosal layer of the tube to secure the fimbriae in their new position.
• Step 13: Additional Techniques - Other techniques may be employed to repair the fimbriae, including ostial stretching, deagglutination, and/or lysis of perifimbrial adhesions.
• Step 14: Verification of Patency - Additional indigo carbine dye is injected into the uterus to verify the patency of the fallopian tube, ensuring that the procedure has been successful.

3. Post-Procedure

After the laparoscopic fimbrioplasty, patients can expect a recovery period that may vary based on individual circumstances. Post-procedure care typically includes monitoring for any signs of complications, such as infection or excessive bleeding. Patients are usually advised to rest and may be given specific instructions regarding activity levels, pain management, and follow-up appointments. It is important for patients to report any unusual symptoms to their healthcare provider promptly. The expected recovery time is generally shorter than that of open surgical procedures, allowing for a quicker return to normal activities.