Cpt code for co2 laser ablation of vaginal cuff

Removing mesh from the vagina, particularly at the vaginal vault, can be a difficult task for many vaginal surgeons. A limited surgical field within the vagina results in poor exposure, inadequate visualization, and technically difficult dissections. This may explain previous reports of poor surgical outcomes after multiple attempts of mesh excision. To improve success rates in complicated cases of recurrent vaginal mesh erosions, visualization and exposure must be maximized. Thus, we describe a safe, successful, and reproducible surgical technique for the treatment of recurrent vaginal mesh erosion using colposcopy, laparoscopy, and the CO 2 laser. In 1963, the development of carbon dioxide light amplification by stimulated emission of radiation (CO 2 LASER) by Kumar Patel 5. Are slings now the gold standard treatment for the management of female urinary stress incontinence and if so which technique?. Corresponding author. Address correspondence to: Benjamin J. Steinberg, 6012 Piazza at Main Street, Voorhees, NJ 08043, USA. Telephone: (856) 325-6622, Fax: (856) 325-6522, E-mail: Vaginal mesh extrusion after transvaginal repair of cystocele using a prosthetic mesh: treatment and functional outcome. CASE REPORT The patient is a 58-y old woman status post-Mentor ObTape placement in November 2005 who presented with a 3-y history of vaginal discharge and spotting. Physical examination in the office revealed a foreign body at the apex of the vagina. A 1-cm x3-cm portion of the graft material consistent with ObTape was excised in the office. Following this, despite conservative management with vaginal estrogen cream and silver nitrate cautery, the patient was noted to have persistent granulation tissue at the excision site. Subsequently, in April 2008, she underwent a surgical vaginal excision of the foreign body in the operating room. Due to persistent symptoms of vaginal discharge and spotting and subsequent discussions with the patient, a second vaginal mesh excision was repeated with extensive vaginal surgical exploration of her right space of Retzius in August 2008. Because both procedures were unsuccessful, a combined abdominal and vaginal approach was then considered to potentially alleviate these symptoms. Based on previous reports describing success using the CO 2 laser in gynecologic surgery, we performed CO 2 laser vaporization under colposcopic and laparoscopic guidance. Karolynn T. Echols Cooper University Hospitals, Division of Female Pelvic Medicine and Reconstructive Surgery, Camden, NJ, USA. Find articles by Karolynn T. Echols. In cases of recurrent mesh erosions, poor surgical outcomes despite multiple resections have been reported. The purpose of this case report is to describe an innovative surgical approach using CO 2 laser vaporization under colposcopic and laparoscopic guidance for the treatment of persistent granulation tissue due to recurrent vaginal mesh erosion. Case Description: A 58-y-old postmenopausal woman first presented with a 3-y history of vaginal discharge and spotting after undergoing a Mentor ObTape transobturator sling (Mentor Corp, Santa Barbara, CA), for the treatment of stress urinary incontinence. Despite surgical removal of the mesh and multiple attempts at cauterization of persistent granulation tissue, her symptoms persisted. Tiffany Mapp Peconic Bay Medical Center, River Head, NY, USA. Find articles by Tiffany Mapp. RESULTS Postoperatively, the patient denied any symptoms of vaginal discharge, vaginal spotting, or dyspareunia. Four weeks after surgical excision of the mesh, her examination revealed a well-healed vagina without any change in vaginal length. Currently, the patient is 18 mo postprocedure without any complaints of vaginal bleeding, vaginal discharge, or dyspareunia. All Databases Assembly Biocollections BioProject BioSample BioSystems Books ClinVar Clone Conserved Domains dbGaP dbVar EST Gene Genome GEO DataSets GEO Profiles GSS GTR HomoloGene Identical Protein Groups MedGen MeSH NCBI Web Site NLM Catalog Nucleotide OMIM PMC PopSet Probe Protein Protein Clusters PubChem BioAssay PubChem Compound PubChem Substance PubMed SNP Sparcle SRA Structure Taxonomy ToolKit ToolKitAll ToolKitBookgh UniGene. described the most common presentation of vaginal mesh erosions following Merslene suburethral slings to be vaginal discharge, followed by vaginal bleeding, voiding dysfunction, and pain or dyspareunia, respectively. While vaginal estrogen cream may be considered first-line treatment for vaginal mesh erosion, 59% of patients will still require surgical intervention. 4. demonstrates the preoperative transvaginal view of the apical granulation tissue. We first infiltrated the proposed infraumbilical incision with 5cc of plain 0.25% marcaine and entered the preperitoneal space with the Optiview Trocar (Ethicon Inc., Somerville, NJ). Opening pressures were kept at 12mm Hg. The space of Retzius was accessed by blunt dissection. Following this, right and left lower quadrant 5-mm trocars were introduced under direct visualization. This allowed the Nezhat-Dorsey (C.R. Bard Inc., Madison, GA) suction-irrigator with a unipolar cautery tip and the blunt probe to be inserted safely. The entire space of Retzius was then opened with particular attention being placed to the right side where Cooper's ligament was identified clearly. Accessory obturator vessels were identified ( Figure 2 ). The right paravaginal spaces were then dissected. A second left-sided 5-mm port was then introduced superior and slightly lateral to the left lower quandrant port. An atraumatic bowel grasper was used to deviate the bladder and the bladder neck medially, allowing better exposure to the paravaginal space. Careful dissection was performed until the pubic symphysis and pubic rami were reached. The Space of Retzius was filled with sterile water to protect the area from CO 2 laser injury during vaginal fulguration. Using the colposcope, the remaining granulation tissue located in the right paravaginal space was identified then fulgurated using the CO 2 laser under direct visualization set at a power of 5 W. We then connected the vaginal laser dissection with the suprapubic dissection, increasing the likelihood that the retained mesh could be exposed and removed in its entirety. After ablating a 2-cm x1-cm area of the vagina to a depth between 2mm to 4mm, the remaining 3-cm portion of ObTape was removed from the vagina and sent to pathology for analysis. The vaginal epithelium was reapproximated utilizing 2-0 Monocryl in an interrupted fashion ( Figure 3 ). Cystoscopy revealed a normal-appearing bladder and urethr. marked the beginning of a new age in minimally invasive surgery. A beam of infrared light produced from the CO 2 laser has a wavelength of 10,600nm. Water, a major component of biological tissues, absorbs this frequency of light, making it an effective tool in surgical procedures. Our decision to utilize the CO 2 laser in this case of vaginal mesh erosion was based on several factors. Today, the CO 2 laser is considered a safe and effective surgical tool for the treatment of many gynecologic conditions, such as endometriosis, cervical intraepithelial neoplasia, condylomas, vulvar and vaginal lesions, as well as Bartholin's gland cysts. Also, advantages of the CO 2 laser in gynecologic surgery include accuracy, precision, rapid healing, minimal tissue destruction, and minimal scar formation. 6. Saifuddin Mama Cooper University Hospitals, Division of Female Pelvic Medicine and Reconstructive Surgery, Camden, NJ, USA. Find articles by Saifuddin Mama. However, one of the known complications of vaginal mesh placement is mesh erosion with reported occurrences as high as 30%. 2. Peconic Bay Medical Center, River Head, NY, USA. Continuous-wave laser action on vibrational-rotational transitions of CO 2. Gynecologic surgery using the CO2 laser (light amplification by stimulated emission of radiation). Deffieux X, Huel C, de Tayrac R, et al. Cooper University Hospitals, Division of Female Pelvic Medicine and Reconstructive Surgery, Camden, NJ, USA. Introduction: There have been many reports in the literature on vaginal mesh erosion as a complication of pelvic floor reconstructive surgery. Several reports describe successful surgical excision of the exposed mesh as a resolution. However, in rare cases of mesh erosion, poor surgical outcomes and multiple resection failures have been reported. We describe an innovative surgical approach to persistent vaginal mesh erosion using CO 2 laser vaporization under colposcopic and laparoscopic guidance. Sopracordevole F, Moriconi L, Di Giuseppe J, et al. Laser Excisional Treatment for Vaginal Intraepithelial Neoplasia to Exclude Invasion: What Is the Risk of Complications? J Low Genit Tract Dis. 2017;21(4):311-314. Piovano E, Macchi C, Attamante L, et al. CO2 laser vaporization for the treatment of vaginal intraepithelial neoplasia: effectiveness and predictive factors for recurrence. Eur J Gynaecol Oncol. 2015;36(4):383-388. It can be repeated, if needed, and rarely causes problems or side effects. Treatment Options for Vaginal Cancer by Stage and Type. Still, this is not a treatment for invasive cancer. For laser surgery to be an option, the doctor must be certain that the worst lesion was tested and it's not invasive cancer. For more information on laser surgery, see Lasers in Cancer Treatment. The American Cancer Society medical and editorial content team. National Cancer Institute. Vaginal Cancer Treatment (PDQ)–Patient Version. October 13, 2017. Accessed at www.cancer.gov/types/vaginal/patient/vaginal-treatment-pdq on March 12, 2018. Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing. Treatment Options for Vaginal Cancer by Stage and Type. Imagine a world free from cancer. Help make it a reality. In laser surgery, a beam of high-energy light is used to vaporize the abnormal tissue. This treatment works well for vaginal pre-cancer (vaginal intraepithelial neoplasia or VAIN), and can even be used for large lesions (areas of abnormal cells). 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