SOP Exhibits

Title:

Annex A - List of Surgical Operations for Gynecological Disorders

SOP Number : HR-PB56.A

_{Vulva, Perineum}_,_{and lntroitus}

_Procedure	Disease	Classification*
Incision and drainage of vulvar or perineal abscess/masses	Vulvar or perineal abscess	Minor
Incision and drainage of Bartholin's gland abscess	Bartholin's glandabscess	Minor
Marsupialization of Bartholin's gland cyst	Bartholin's gland cyst	Minor
Lysis of labial adhesions	Labial adhesions	Minor
Biopsy of vulvar or perineal masses	Vulvar warts Vulvar Masses	Minor
Electracautery of vulvar warts	Vulvar Warts	Minor
Vulvectomy simple; partial or complete	Vulvar Masses	Major
Vulvectomy, radical, partial;	Vulvar carcinoma	Major
w/unilateral inguinofemoral lymphadenectomy
w/bilateral inguinofemoral lymphadenectomy
Vulvectomy, radical, complete;	Vulvar carcinoma	Major
w/ unilateral inguinofemoral lymphadenectomy
w/bilateral inguinofemoral lymphadenectomy
Vulvectomy, radical, complete, w/ inguinofemoral, iliac, and pelvic lymphadenectomy	Vulvar carcinoma	Major
Partial hymenectomy or revision of hymenal ring	Imperforate hymen	Minor
Hymenotomy, simpleincision	Imperforate hymen	Minor
Excision of Bartholin's gland or cyst	Bartholin's gland cyst/abscess	Minor

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List of Surgical Operations for Gynecological Disorders

Procedure	Disease	Classification
Biopsy of vaginal mucosa and/ or masses	Vaginal warts, vaginal masses	Minor
Colpocleisis (Le Fort Type)	Uterine prolapse	Major
Excision of vaginal septum	Tranverse vaginal septum	Minor
Excision of vaginal cyst or tumor	Vaginal cyst Vaginal masses	Minor
Insertion of uterine tandems and/ or vaginal ovoids for clinical brachytherapy	Cervical or endometrial cancer	Minor
Colporrhaphy, suture of injury of vagina (nonobsterical)	Trauma	Minor
Colpoperineorrhaphy, suture of injury of vagina and/or perineum (nonobstetrical)	Trauma	Minor
Plastic operation on urethral sphincter, vaginal approach (eg, Kelly urethral plication)	Urethrocele	Minor
Plastic repair of urethrocele	Urethrocele	Minor
Anterior and/or posterior colporrhaphy	Cysto+/-urethrocele	Major
Anterior and/or posterior colporrhaphy, w/ or w/o perineorrhaphy	Rectocele	Major
Combined anteroposterior colporrhaphy;	Cystocoele with rectocele	Major
w/ enterocele repair	Pelvic organ prolapse	Major
Repair of enterocele, vaginal approach	Pelvic organ prolapse	Major
Repair of enterocele, abdominal approach	Pelvic organ prolapse	Major
Colpopexy, abdominal approach	Pelvic organ prolapse	Major
Sacrospinous ligament fixation for prolapsed of vagina	Pelvic organ prolapse	Major
Prespinous on lliococcygeal ligament fixation	Pelvic organ prolapse	Major
Paravaginal defect repair (including repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse)	Pelvic organ prolapse	Major
Sling operation for stress incontinence (e g, fascia or synthetic)	Urinary stress incontinence	Major
Burch calposuspension/ retroposbic urethroprosy	Urinary stress incontinence	Major
Pereyra procedure, including anterior colporrhaphy	Urinary stress incontinence	Major

Vagina

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List of Surgical Operations for Gynecological Disorders

Procedure	Disease	Classification
Repair of rectovaginal fistula; Vaginal or transanal approach	Rectovaginal fistula	Major
abdominal approach	Rectovaginal fistula	Major
abdominal approach,w/ concomitant colostomy	Rectovaginal fistula	Major
Repair of urethrovaginal fistula;	Urethrovaginal fistula	Major
w/bulbocavernosus transplant		Major
Repair of vesicovaginal fistula; vaginal approach	Vesicovaginal fistula	Major
Transvesical and vaginal approach
Removal of impacted vaginal foreign body under anesthesia	Retained foreign body	_Minor
Laparoscopy, surgical, colpopexy (suspension of vaginal apex)	Pelvic organ prolapse	Major
Colposcopy (Vaginoscopy)	Vaginal intraepithelial lesions	Minor
Colposcopy; w/biopsy(s) of the cervix and/or endocervical curettage	Vaginal andcervical intraepithelial lesions	Minor
Colposcopy; w /loop electrode excision procedure of the cervix	Cervical intraepithelial lesions	Minor

Cervix

Procedure	Disease	Classification
Cervical Biopsy,single or multiple, or local excision of lesion,w/or w/o fulguration	Cervical pathology	Minor
Cauterization of cervix; any Method	Cervical warts	Minor
Conization of cervix, w/or w/o fulguration, w/ or w/o dilation and curettage, w/ or w/o repair; cold knife or laser loop electrode excision	Cervical intraepithelial neoplasia	Minor
Trachelectomy (cervicectomy), amputation of cervix	Cervical masses	Major
Excision of cervical stump, abdominal approach; w/ or w/o pelvic floor repair	S/p subtotal hysterectomy	Major
Excision of cervical stump,vaginal approach; w/anterior and/or Posterior repair w/ repair of _enterocele	S/p subtotal hysterectomy+/ pelvic organ prolapse	Major _.

Page 3 of 9 List of Surgical Operations for Gynecological Disorders

Procedure	Disease	Classification
Tracheloraphy, plastic repair of uterine cervix, vaginal approach	Cervical lacerations	Minor
Cerclage of cervix, during pregnancy; vaginal abdominal	Cervical incompetence	Major
Hysterorrhaphy of ruptured uterus	Cervical incompetence	Major

Uterus

Procedure	Disease	Classification
Endometrial sampling (biopsy) w/ or w/o endocervical sampling (biopsy), w/o cervical dilation, any method	Uterine pathologies	Minor
Dilation and curettage	Uterine pathologies	Minor
Vaginal Myomectomy, excision of fibroid tumor of uterus, single or multiple	Uterine pathologies	Minor
Myomectomy, excision of fibroid tumor of uterus, single or multiple; abdominal approach	Uterine pathologies	Major
Total abdominal hysterectomy (corpus and cervix), w/ or w/0_r_{emoval of tube(s), w/ or w/o removal of ovary(s);}	Uterine, ovarian and fallopian pathologies	Major
Supracervical abdominal hysterectomy (subtotal ^{hysterectomy), w/ or w/o removal} of tube(s), w/ or w/o removal of ovary(s)	Uterine, ovarian and fallopian tube pathologies	Major


Total abdominal hysterectomy, including partial vaginectomy, w/ para-aortic and pelvic lymph node sampling, w/ or w/o removal of �tube(s), w/ or w/o removal _{of ovary(s)}	Uterine, ovarian, fallopian tube malignancies	Major
Radical abdominal hysterectomy, w/ bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), w/ or w/o removal of tube(s), w/ or w/o removal of ovary(s)	Uterine, ovarian malignancies	Major

Page 4 of 9 List of Surgical Operations for Gynecological Disorders

Procedure	Disease	Classification
Pelvic excenteration for gynecologic malignancy, w/ total abdominal hysterectomy or cervicectomy w/ or w/o removal of tube(s), w/ or w/o removal of ovary(s), w/ removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or combination thereof	Uterine, ovarian, fallopian tube malignancies	Major
Vaginal hysterectomy;	Pelvic organ prolapse/stress urinary incontinence	Major
w/ removal of tube(s), and/or ovary(s)	Pelvic organ prolapse/stress urinary incontinence	Major
w/ removal of tube(s), and/or ovary(s), w/ repair of enterocele	Pelvic organ prolapse/stress urinary incontinence	Major
w/ colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type, w/ or w/o endoscopic control)	Pelvic organ prolapse/stress urinary incontinence	Major
w/ repair of enterocele	Pelvic organ prolapse/stress urinary incontinence	Major
Vaginal hysterectomy, w/ total or partial calpectomy;	Pelvic organ prolapse/stress urinary incontinence	Major
w/ repair of enterocele	Pelvic organ prolapse/stress urinary incontinence	Major
Vaginal hysterectomy, radical (Schauta type operation)	Pelvic organ prolapse associated cervical cancer	Major
Uterine suspension, w/ or w/o shortening of round ligaments, w/ or w/o shortening of sacrouterine ligaments	Pelvic organ prolapse	Major
Hysterorrhaphy, repair of ruptured uterus (nonobestetrical)	Non-obstetrical uterine rupture (e.g. trauma)	Major
Hysteroplasty, repair of uterine anomaly (Strassman type)	Mullerian anomalies, eg. Septate uterus	Major
Laparoscopy, surgical, myomectomy, excision; intramural myomas and/or removal of surface myomas	Uterine pathologies	Major
Laparoscopy surgical,, with vaginal hysterectomy; with removal of tube(s) and/or ovary(s)	Uterine pathologies	Major

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Procedure	Disease	Classification
Hysteroscopy, diagnostic	Uterine pathologies	Minor
Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C	Uterine pathologies	Minor
With lysis of intrauterine adhesions (any method)	Uterine pathologies	Minor
with division or resection of intraterine septum (any method)	Uterine pathologies	Minor
with removal of leiomyomata	Uterine pathologies	Minor
with removal of impacted foreign body	Uterine pathologies	Minor
with endometrial ablation (e.g.,) endometrial resection, electrosurgical ablation thermoablation	Uterine pathologies	Minor
with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants	Uterine pathologies	Minor
Laparoscopy, surgical; with lysis of adhesions (salphingolysis)	Fallopian tube pathologies	Minor
with removal of adnexal structures (partial or total oophorectomy and/ or salpingectomy)	Fallopian tube pathologies	Major
With fulguration or excision of Lesions of the ovary, pelvic viscera, or peritoneal surface by any method	Fallopian tube pathologies	Minor
With fulguration of oviducts (with or without transection)	Fallopian tube pathologies	Minor
With occlusion of oviducts by device (e.g., bond, clip, or Falope ring)	Fallopian tube pathologies
With fimbrioplasty	Fallopian tube pathologies	Major
With salphingostomy (salpingoneostomy)	Fallopian tube pathologies	Major

Oviduct

Procedure	Disease	Classification
Tubal Reanastomosis	Fallopian tube pathologies	Major
Salpingectomy, complete or partial , Unilateral or bilateral	Fallopian tube pathologies	Major
Salpingo-oophorectomy, complete or partial, unilateral or bilateral	Fallopian tube and ovarian pathologies	Major

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Procedure	Disease	Classification
Lysis of adhesions (salpingolysis)	Fallopian tube pathologies	Major
^{Fimbrioplasty}	Fallopian tube pathologies	Major
^{Salpingostomy} ^{(Salpingoneostomy)}	Fallopian tube pathologies	Major
Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method) w/ or w/o hysterosalpingogrophy	Fallopian tube pathologies	Major

Ovary

Procedure	Disease	Classification
Aspiration of ovarian cyst(s), unilateral or bilateral; vaginal Approach	Ovarian cyst	Minor
Drainage of ovarian abscess; Vaginal approach	Tuboovarian abscess	Minor
Ovarian cystectomy, unilateral or bilateral	Benign ovarian cysts(e.g. endometriotic cyst, dermoid cyst, serous cystadenoma, mucinous cystadenoma)	Major
Oophorectomy, partial or total, Unilateral or bilateral;	Benign ovarian cysts	Major
^For^{ovarian malignancy, w/para-} aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal biopsies, diaphragmatic assessments, w/ or w/o salpingectomy(s), w/ or w/o peritoneal biopsies, diaphragmatic assessments, w/ or w/o salpingectomy(s), w/ or w/o omentectomy	Ovarian cancer	Major
Resection of ovarian malignancy w/bilateral salpingo- oophorectomy and omentectomy;	Ovarian cancer	Major
w/total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy	Ovarian cancer	Major
w/ radical dissection for debulking	Ovarian cancer	Major

Page7 of 9 List of Surgical Operations for Gynecological Disorders

Procedure	Disease	Classification
Laparotomy for staging or restaging of ovarian malignancy (“second look”), w/ or w/o omentectomy, peritoneal washing, biopsy of abdominal and pelvic peritoneum, diaphragmatic assessment w/ pelvic and limited para-aortic lymphadenectomy	Ovarian cancer	Major
^Ovariolysis	Lysis of adhesions	Major

Breast procedures

Procedure	Disease	Classification
Puncture aspiration of cyst of breast	Simple breast cyst, _{Fibrocystic change}	Minor
^Mastotomyw/ ^{exploration or drainage of abscess deep}	Breast abscess/Mastitis	Minor
Biopsy of breast; needle core, fine _{Needle aspiration}	Breast mass, benign or _malignant	Minor
_{Excision of lactiferous duct fistula}	_{Intraductal Papilloma}	Minor
Excision of cyst, fibroadenoma, or _{other benign breast masses}	Fibroadenoma, Flbrocystic _change	Minor
Incision/Excision biopsy	Benign breast masses or _{Breast cancer}	Minor
Wide excision	Phyllodestumor;Ductal carcinomain-situ,Lobular _{Carcinoma in-situ}	Major
TotalMastectomy	Phyllodes tumor,Ductal carcinoma in-situ, Lobular carcinoma in-situ	Major
_{Mastectomy, subcutaneous}	_{Silicone Mastitis}	Major
Radical/ModifiedRadicalMastectomy	Breast cancer	Major
Lumpectomy/quadrantectomy, _{axillary node dissection}	Breast cancer	Major
Lumpectomy, sentinel node biopsy+/ _{axillary node dissection}	Breast cancer	Major
Breast reconstruction with latissimus dorsi flap,with or without prosthetic implant	Breast cancer, Phyllodes tumor, Ductal carcinoma in- situ, lobular carcinoma in-situ (after mastectomy)	Major
Breast reconstruction with free flap	Breast cancer, Phyllodes tumor, Ductal carcinoma in- situ, lobular carcinoma in-situ (after mastectomy)	Major
Breast reconstruction with other technique	Breast cancer, Phyllodes tumor, Ductalcarcinoma in- situ, lobular carcinoma in-situ (after mastectomy)	Major

Page 8 of 9 List of Surgical Operations for Gynecological Disorders

Procedure	Disease	Classification
Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM)	Breast cancer, Phyllodees tumor, Ductal carcinoma in-situ, lobular carcinoma in-situ (after mastectomy)	Major

Legend:

*Classification refers to the estimated period of one’s recuperation after surgery,
if without concomitant medical problems.

Minor-pertains to one’s estimated period of recuperation requiring a maximum of two weeks
Major-pertains to one’s estimated period of recuperation more than three weeks to two months

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List of Surgical Operations for Gynecological Disorders