Japan Bangladesh Friendship Hospital

Endoscopic and Laparoscopic Surgery Center

                   

 

As used in this policy, endoscopic surgery is a general term describing a form of minimally invasive surgery in which access to a body cavity is achieved through several small percutaneous incisions. The surgery is performed using specialized instrumentation inserted through the incisions (i.e., trocar sites) and guided by the use of a fiber-optic endoscope that provides visualization of the body cavity on a video screen. In endoscopic surgery, the surgeon does not have direct visualization of the surgical field, and thus endoscopic techniques require specialized skills compared to the corresponding open surgical techniques. Endoscopic surgery may also refer to the use of a fiberoptic endoscope inserted through a body orifice into a body cavity such as the gastrointestinal tract, bronchi, uterus, or bladder. These applications of endoscopic surgery are not addressed by this policy.

While endoscopic surgery is a general term, laparoscopic, thoracoscopic, and arthroscopic surgery describe endoscopic surgery within the abdomen, thoracic cavity, and joint spaces, respectively. In most instances, the endoscopic technique attempts to duplicate the same surgical techniques and principles as the corresponding open techniques, with the only difference being surgical access. For example, laparoscopic cholecystectomy, performed since 1990, espouses the same surgical principles as open cholecystectomy. The advantages of endoscopic surgery include shorter hospital stays and more rapid recovery such that the patient may be able to return to work promptly. Disadvantages include a longer operative time, particularly if the surgeon is early on the learning curve for these new techniques.

Some endoscopic approaches entail novel surgical principles, and thus raise issues of safety and effectiveness apart from the safety and effectiveness of the endoscopic approach itself. For example, open herniorrhaphy is typically done from an inguinal approach, while laparoscopic herniorrhaphy involves a unique abdominal approach. In other procedures, the surgical dissection can be done entirely with endoscopic guidance, but the resulting surgical specimen may be too large to remove through the small trocar incision. Novel approaches have been devised to overcome this limitation. For example, in laparoscopic splenectomy or nephrectomy, the resected specimens are placed into a bag intra-abdominally, morcellated, and then removed through a small muscle-splitting incision. Similarly, laparoscopic colectomy specimens can be removed through either a muscle-splitting incision, or transanally for distal specimens. Surgeries can combine an open and laparoscopic approach; for example laparoscopic-assisted vaginal hysterectomy may entail a laparoscopic surgical dissection, with removal of the specimen through a vaginal incision similar to an open vaginal hysterectomy.

In most instances it is assumed that an endoscopic approach is a direct substitution for the corresponding open approach. However, the decreased morbidity of endoscopic surgeries in general may broaden the patient selection criteria for certain surgeries. For example, open gastric fundoplication is typically limited to those patients who have failed medical management with H-2 blockers and antimotility agents. Now, however, laparoscopic fundoplication may be considered an alternative to lifelong medical management. Similarly, open plantar fasciotomy is typically reserved for those symptomatic patients who have failed a prolonged attempt at conservative management. The decreased morbidity of an endoscopic approach may prompt a shortened period of conservative management.

Endoscopic, laparoscopic, and thoracoscopic CPT codes for which there are CPT codes for the corresponding open surgical procedure are summarized below. Not included are those CPT codes describing endoscopic diagnostic procedures and those describing arthroscopic procedures, with the exception of endoscopic carpal tunnel release and endoscopic plantar fasciotomy. The following table correlates the laparoscopic CPT code with the corresponding open procedure.


JBFH Endoscopic and Laparoscopic Surgeon: Prof. Sardar A. Nayeem

 

 

Our Endoscopic & Laparoscopic Surgeon: