Smit Sleeve Placement, Insertion, Removal, CPT Code

A Smit sleeve is a temporary indwelling intrauterine tube inserted into the internal os of the cervical cavity to facilitate simpler surgical anatomic characterization of cervical malignancy. The device is made of medical-grade polymers, and it features wing extensions to assist it to stay in place while identifying landmarks for potential future therapy. After that, CT or MRI scans can be used to visualize the lesion, allowing for more precise brachytherapy treatment as cancer progresses.

It is a disposable intrauterine tube made of silicone that is placed inside the uterus before a brachytherapy medication for cervical cancer is administered. During tandem insertion, the flange on the tube's distal end serves as a stopper. The Smit sleeve cannula marginally enlarges the radius around the tandem, while the sleeve's base, which is located distant from the external cervical os, displaces the ovoids.

Placement

For simpler surgical anatomic localization of cervical cancer, a disposable indwelling intrauterine tube called a Smit sleeve is inserted into the internal os of the cervical cavity. In most cases, it is attached to the cervix while the patient is under anesthesia and being sedated for the procedure. For brachytherapy for cervical cancer, the Smit sleeve is utilized to simplify the insertion of the intrauterine tandem by remaining in situ during treatment. It is possible to pack gauze around the ring and tandem to hold it in place, which might cause discomfort.

Insertion

To begin the process of intracavitary brachytherapy, the patient will first undergo cervical dilatation, which can either be performed under general or spinal anesthesia. A series of dilatations are conducted, beginning with a thin rod having a low Hegar number and increasing to a thicker rod with a higher Hegar number. The Smit sleeve is then put into the cervical canal and sewn to it to guarantee that the cervix remains patent throughout the brachytherapy treatment. When the patient has recovered and been discharged, she will return for four to five treatments on separate days. During these treatments, a tandem will be inserted into the Smit sleeve, and ring or ovoid attachments will be made to the tandem on both of its sides. This will enable the administration of radiation into the ring or ovoid channels, which will then treat the cervix and the tissues that are directly adjacent to it.

Removal

The radiation oncologist will take off your Smit Sleeve following your final treatment. On the first day of treatment, you will receive an anesthetic, and on days two and three, you will be given sleep medication. After treatment, you could feel sleepy for a few hours.

During treatment for cervical cancer, the risks of removing the Smit sleeve include uterine perforation, short-term and long-term effects that could affect physical and emotional health, and the need for general anesthesia during brachytherapy. 

CPT Code

The most suitable CPT code for a Smith sleeve procedure is 57155 with a -52 modifier to indicate the reduced amount of work involved in the procedure. Other codes, such as 77789 for surface application of radiation source, and possibly even more, may be billed as part of the therapy as well.