55866

Laparoscopic radical prostatectomy (LRP)

Laparoscopic radical prostatectomy (CPT 55866) is a minimally invasive surgical procedure performed to remove the entire prostate gland and the attached seminal vesicles, typically as a definitive treatment for localized prostate cancer. The procedure is performed through several small incisions in the abdominal wall, through which a laparoscope and specialized surgical instruments are inserted. In modern urological practice, this is frequently performed using robotic assistance (e.g., the Da Vinci system), although it is still coded under the laparoscopic descriptor 55866. The surgeon begins the procedure by creating a pneumoperitoneum and placing surgical ports. The dissection typically involves identifying the bladder neck and carefully separating it from the base of the prostate. The seminal vesicles and vasa deferentia are then isolated, clipped, and divided. One of the most critical components of the procedure is the preservation of the neurovascular bundles, known as nerve-sparing, which is essential for post-operative erectile function and urinary continence. This step is explicitly included in the 55866 descriptor when performed. The dorsal venous complex is controlled using sutures or energy devices to minimize blood loss. The prostate is then dissected from the rectum and the urethra is divided at the prostatic apex. Following removal of the specimen, the bladder neck is reconstructed and a vesicourethral anastomosis is performed to reconnect the bladder to the urethra over a Foley catheter. A pelvic lymph node dissection may be performed concurrently but is reported with separate codes. The laparoscopic approach offers significant benefits over open surgery, including reduced intraoperative blood loss, shorter hospital stays, and a quicker return to normal activities for the patient.

Clinical Indications

  • Clinically localized prostate cancer (Stage T1 or T2)
  • Locally advanced prostate cancer (Stage T3) in select patients as part of multimodal therapy
  • High-risk prostate cancer based on Gleason score or PSA levels where surgical extirpation is indicated
  • Failure of radiation therapy (salvage prostatectomy)
  • Patient preference for surgical management over active surveillance or radiation

Procedure Steps

  1. Administration of general anesthesia and patient positioning in steep Trendelenburg.
  2. Establishment of pneumoperitoneum and placement of laparoscopic/robotic ports.
  3. Dissection of the space of Retzius to expose the prostate and bladder.
  4. Incision of the endopelvic fascia and ligation of the dorsal venous complex (DVC).
  5. Dissection of the bladder neck and identification of the ureteral orifices.
  6. Mobilization and excision of the seminal vesicles and vasa deferentia.
  7. Nerve-sparing dissection along the lateral aspects of the prostate if oncologically appropriate.
  8. Division of the urethra at the prostatic apex and removal of the specimen in a retrieval bag.
  9. Creation of the vesicourethral anastomosis using running or interrupted sutures.
  10. Leak testing of the anastomosis and placement of a surgical drain and Foley catheter.

Coding Guidelines

  • CPT 55866 includes nerve sparing when performed; do not report nerve sparing as a separate procedure.
  • Robotic-assisted prostatectomy is reported using 55866; do not use unlisted codes or modifier 22 solely for the use of the robot.
  • Pelvic lymphadenectomy is not bundled into 55866; report 38571 (bilateral total pelvic lymphadenectomy) or 38572 (extended) separately if performed.
  • Intraoperative cystoscopy (52000) for checking the anastomosis or ureteral patency is generally considered bundled into the primary procedure.
  • For an open radical retropubic prostatectomy, use codes 55840-55845 instead of 55866.

Associated ICD-10 Codes