The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on laparoscopic cystectomy.
It replaces the previous guidance on laparoscopic cystectomy (NICE interventional procedures guidance 26, December 2003).
This procedure is used to treat
- Invasive bladder carcinoma
- Ongoing incontinence due to paraplegia, where catheterisation results in infection and ongoing leakage
- Refractory complications in a defunctionalized bladder, where urinary diversion is already established
Laparoscopic cystectomy involves removing the bladder using small cuts (also known as 'keyhole surgery'). In women, the bladder is removed through the wall of the vagina. In men, the bladder is removed with the prostate gland, through a small cut in the wall of the abdomen. The tubes that carry urine from the kidneys to the bladder (the ureters) may then be connected to a bag worn outside the body, or parts of the bowel can be used to make an artificial bladder which is drained by a connection to the abdomen wall or to the tube that carries urine out of the body (the urethra).
In OPCS-4 category M34.- Total excision of bladder is used to classify a range of excisions of the bladder: the code selected will be dependent upon what is documented in the patient’s clinical record.
M34.3 Cystectomy NEC
M34.4 Simple cystectomy
M34.8 Other specified total excision of bladder
M34.9 Unspecified total excision of bladder
The codes above would then be supplemented with an additional code to denote the laparoscopic approach. There are a range of codes within Y75.- Minimal access to abdominal cavity that can be used:
Y75.1 Laparoscopic assisted approach to abdominal cavity
Y75.2 Laparoscopic approach to abdominal cavity NEC
Y75.3 Robotic minimal access approach to abdominal cavity
Y75.4 Hand assisted minimal access approach to abdominal cavity
Y75.5 Laparoscopic ultrasonic approach to abdominal cavity
Y75.8 Other specified minimal access to abdominal cavity
Y75.9 Unspecified minimal access abdominal cavity
Note: If concurrent construction of ileal conduit is carried out, a further additional code is required.