CPT® Code 58760

1. Indications

The fimbrioplasty procedure is indicated for the following conditions:

• Agglutination or Clubbing of the Fimbriae - This condition involves the abnormal adhesion or fusion of the fimbriae, which can obstruct the passage of the egg from the ovary into the fallopian tube.
• Filmy Adhesions - These are thin bands of scar tissue that can form around the fallopian tubes and ovaries, potentially leading to infertility or complications during conception.
• Hydrosalpinx - This condition is characterized by the accumulation of fluid in the fallopian tube, which can occur without complete closure of the ostium, affecting fertility.

2. Procedure

The fimbrioplasty procedure involves several key steps to ensure effective treatment of the fimbriae:

• Step 1: Abdominal Incision - The procedure begins with the surgeon making an incision in the lower abdomen to access the reproductive organs. This allows for direct visualization and manipulation of the fallopian tubes and surrounding structures.
• Step 2: Visual Inspection - Once the abdominal cavity is opened, the surgeon visually inspects the uterus, fallopian tubes, and ovaries to assess the condition of the fimbriae and identify any adhesions or abnormalities that need to be addressed.
• Step 3: Distension of the Fallopian Tube - To facilitate the procedure, a cannula is placed vaginally into the uterus, and indigo carbine solution is injected into the fallopian tube. This distension helps to visualize the fimbriae and assess their patency.
• Step 4: Lysis of Adhesions - The surgeon carefully lyses any adhesions surrounding the fallopian tube, ovary, and round ligament to free these structures and restore normal anatomy.
• Step 5: Opening the Clubbed End - Using electrocautery, the clubbed end of the fallopian tube is opened to allow for better access to the fimbriae.
• Step 6: Elevation of the Serosal Layer - Microforceps are employed to elevate the serosal layer that covers the end of the tube, ensuring that the fimbriae can be adequately accessed and treated.
• Step 7: Transection of Scarred Tissue - The scarred serosal tissue is picked up with microforceps and transected to expose the fimbriae, allowing for further manipulation and repair.
• Step 8: Prolapse of Fimbriae - The scarred serosal tissue is folded back, enabling the fimbriae to prolapse out of the tube, which is essential for restoring their function.
• Step 9: Irrigation - Warm saline solution is used to irrigate the fimbriae, helping to separate them and ensure they are free from any obstructions.
• Step 10: Suturing - The scarred serosal tissue is sutured back to the exterior serosal layer of the tube, securing the fimbriae in their corrected position.
• Step 11: Additional Techniques - Other techniques such as ostial stretching, deagglutination, and/or lysis of perifimbrial adhesions may also be employed to enhance the repair of the fimbriae.
• Step 12: Verification of Patency - Before closing the abdominal incision, 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 fimbrioplasty, patients can expect a recovery period that may involve monitoring for any complications. Post-operative care typically includes pain management and instructions for activity restrictions to promote healing. Patients may be advised to avoid strenuous activities for a specified period and to follow up with their healthcare provider to assess the success of the procedure and monitor for any signs of complications. The verification of tube patency using indigo carbine dye is a critical step that helps ensure the effectiveness of the procedure in restoring normal function to the fallopian tubes.