CPT® Code 58673

1. Indications

The laparoscopic salpingostomy is primarily indicated for the treatment of hydrosalpinx, but it may also be performed for other conditions that cause obstruction of the fallopian tubes. The following are specific indications for this procedure:

• Hydrosalpinx - An accumulation of fluid in the fallopian tube due to obstruction, leading to swelling and potential infertility.
• Other Tubal Obstructions - Conditions that result in blockage of the fallopian tubes, which may impede the passage of eggs or sperm.

2. Procedure

The laparoscopic salpingostomy procedure involves several key steps to ensure effective treatment of the fallopian tube obstruction. The following outlines the procedural steps:

• Step 1: Anesthesia and Incision - The procedure begins with the administration of anesthesia to ensure the patient is comfortable and pain-free. An incision is made just below the umbilicus to allow access to the abdominal cavity.
• Step 2: Trocar Placement and Laparoscope Insertion - A trocar, a sharp instrument used to create an entry point, is inserted through the incision. The laparoscope, equipped with a camera, is then introduced to provide visual access to the internal structures.
• Step 3: Establishing Pneumoperitoneum - Pneumoperitoneum is established by inflating the abdominal cavity with air, which creates space for the surgeon to work and enhances visibility of the organs.
• Step 4: Visual Inspection - The surgeon visually inspects the abdominal cavity, including the uterus, fallopian tubes, and ovaries, to assess the extent of the obstruction and any associated conditions.
• Step 5: Additional Incisions - Two or three additional portal incisions are made in the lower abdomen to facilitate the introduction of surgical instruments necessary for the procedure.
• Step 6: Lysis of Adhesions - Any adhesions surrounding the fallopian tube, ovary, and round ligament are lysed to free the structures and improve access to the affected tube.
• Step 7: Distension of the Tube - The fallopian tube is distended through a transcervical injection of saline or dye, which helps to visualize the internal structure and assess the degree of obstruction.
• Step 8: Opening the Hydrosalpinx - The hydrosalpinx is opened using surgical instruments such as scissors, a micro-needle, or laser. The incision is made from the tube outward toward the ovary, creating a new tubal os.
• Step 9: Inspection of Tubal Mucosa - The edge of the tubal incision is grasped and everted to allow for direct inspection of the tubal mucosa, ensuring that the internal lining is healthy and functional.
• Step 10: Additional Incisions and Verification - Additional radial incisions may be made as needed to further open the tube. To verify the patency of the tube, additional dye may be injected into the uterus, confirming that the tube is open and functional.

3. Post-Procedure

After the laparoscopic salpingostomy, patients are typically monitored for a short period to ensure there are no immediate complications. Post-procedure care may include pain management, instructions for activity restrictions, and follow-up appointments to assess recovery and the success of the procedure. Patients may experience some discomfort or mild pain at the incision sites, which is generally manageable with prescribed medications. It is important for patients to follow their healthcare provider's recommendations regarding activity levels and any signs of complications that should prompt immediate medical attention.