Oophorectomy / Ovarian Cystectomy (Laparoscopic)

CPT 58661
Approach Minimally Invasive
Add-on / Variant CPTs
  • 58662 — Laparoscopy with fulguration or excision of lesions of ovary, tube, or ligament
  • 58700 — Salpingectomy, complete or partial (separate procedure)
Preoperative Diagnosis:

Right [left] [ovarian cyst / adnexal mass / endometrioma / dermoid], [X] cm, [symptomatic / not resolved on surveillance / suspicious features]

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] laparoscopic [oophorectomy / salpingo-oophorectomy / ovarian cystectomy]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

General endotracheal

Indications:

The patient is a [age]-year-old [female] with a right [left] [X]-cm [ovarian cyst / endometrioma / dermoid / complex adnexal mass] with [symptomatic / persistent / suspicious features on imaging (solid component / septations / color Doppler vascularity)]. Serum CA-125 was [X]. Surgical intervention was recommended. The risks, benefits, and alternatives were discussed and informed consent was obtained.

Findings:

A [X]-cm [smooth / multiloculated / dermoid] [cyst / mass] was identified on the right [left] ovary. The cyst was [isolated to the ovary / adherent to the bowel / with endometriosis on the ovarian surface]. The contralateral adnexa was [normal]. The uterus was [normal]. [Peritoneal washings were obtained for cytology.] The cyst was removed [intact / with spill of dermoid / chocolate-colored endometriotic fluid. The abdomen was copiously irrigated].

Description of Procedure:

The patient was positioned in the dorsal lithotomy [/ supine] position with Trendelenburg. A [12-mm] umbilical port was placed via [Veress needle / optical trocar / Hasson open technique]. CO₂ insufflation to [15 mmHg]. Two [5-mm] ports were placed in the lower quadrants under direct vision.

[Peritoneal washings were obtained with 50 mL saline and sent for cytology (if malignancy suspected).]

[OVARIAN CYSTECTOMY:]
The ovary was stabilized with atraumatic graspers. A cortical incision was made over the cyst with [scissors / monopolar]. The cyst was dissected from the ovarian stroma in the avascular plane using [blunt dissection / aquadissection]. The cyst was removed intact [or rupture occurred. Copious irrigation was performed]. The ovarian defect was closed with [3-0 Vicryl / bipolar coagulation to hemostasis without suture]. The cyst was placed in a 10-mm retrieval bag.

[OOPHORECTOMY:]
The infundibulopelvic ligament was identified. The ureter was identified at the pelvic brim before ligation. The IP ligament was [coagulated / stapled] and divided. The utero-ovarian ligament and tube were coagulated and divided. The ovary and tube were placed in a 15-mm retrieval bag.

The bag was extracted through the umbilical port [/ extended incision]. The pelvis was irrigated and hemostasis confirmed.

Complications:

None

Specimens:

Right [left] ovarian cyst [/ ovary ± tube], sent to pathology [and intraoperative frozen section if concern for malignancy]

Estimated Blood Loss:

Minimal

Drains:

None

Disposition:

The patient was taken to the PACU in stable condition. Ambulation was initiated on postoperative day 1. Diet was advanced as tolerated. Same-day discharge [/ admitted overnight] per clinical course.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Right/Left *** cm ovarian cyst/mass, ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left laparoscopic oophorectomy/cystectomy
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General

INDICATIONS: .PTAGE-year-old .PTSEX with *** cm right/left ***. CA-125 ***. Surgical intervention indicated. Consent obtained.

FINDINGS: *** cm *** cyst, ***. Contralateral adnexa normal. [Washings sent.] Cyst removed intact/with spill — irrigated.

PROCEDURE:
Lithotomy/supine, Trendelenburg. Umbilical port [Veress needle / optical trocar / Hasson]. CO2 15 mmHg. *** ports. [Washings.] [Cystectomy: cortical incision, avascular plane blunt dissection, cyst removed intact/rupture, ovary closed.] [Oophorectomy: ureter identified, IP ligament coagulated/divided, utero-ovarian/tube divided, specimen in bag.] Bag extracted. Irrigated, hemostatic.

EBL: Minimal
SPECIMENS: *** to pathology [± frozen]
COMPLICATIONS: None
DISPOSITION: PACU. Ambulate POD 1. Same-day DC/admit.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Endometrioma (Chocolate Cyst) Cystectomy

The cyst contained thick chocolate-colored fluid consistent with endometrioma. To minimize spill, the cyst was aspirated with a laparoscopic needle prior to incision. The cyst wall was stripped from the ovarian stroma in the avascular plane using traction-countertraction technique, taking care to minimize removal of normal ovarian cortex. Bipolar coagulation was used for hemostasis rather than extensive cauterization of the ovarian hilum (which risks ovarian reserve). The abdomen was copiously irrigated to remove all endometriotic fluid. Endometriosis implants on the peritoneum, bowel serosa, and uterosacral ligaments were [excised / fulgurated].

Charting Tips
  • Document ureter identification before IP ligament ligation. The ureter runs beneath the infundibulopelvic ligament and is at risk during oophorectomy. Document 'the right ureter was identified at the pelvic brim before ligation of the IP ligament.' This is mandatory for any adnexal surgery.
  • Document whether cyst rupture occurred and how it was managed. Cyst spill changes intraoperative management (copious irrigation required) and can affect pathologic assessment of the cyst wall (may obscure malignancy). Document rupture, the response, and the final condition of the abdomen.
  • For suspicious masses, document frozen section decision. Intraoperative frozen section guides whether a staging procedure is needed at the same operation. Document the pre-operative suspicion level, whether frozen was sent, and the result if sent.
Billing Tips
  • Bill 58661 for laparoscopic removal of adnexal structures (oophorectomy or salpingectomy, 11.07 wRVU, 10-day global). Bill 58662 for laparoscopic excision of ovarian cyst or endometrioma (11.85 wRVU, 90-day global).
  • 58661 has a 10-day global period when performed for benign disease. 58662 has a 90-day global. Code selection depends on whether the entire adnexa is removed (58661) or cyst excision with ovarian preservation (58662).
  • For open oophorectomy, bill 58700 (salpingectomy, 12.63 wRVU) or 58720 (removal of ovary and tube, 11.86 wRVU, 90-day global). Document open approach and any conversion from laparoscopic.
  • When oophorectomy is performed at the time of hysterectomy, use the combined hysterectomy + BSO code (58152, 58291, etc.) rather than billing oophorectomy separately. Separate billing is appropriate when oophorectomy is the primary standalone procedure.
  • Frozen section for intraoperative diagnosis of ovarian mass is ordered by the surgeon and results should be documented in the operative note. They affect both operative decision-making and pathology billing.