Texas Medical Disclosure Panel‐ Procedures requiring written informed consent‐ UTMB form number Anesthesia 6501 Epidural General Spinal Monitored Anesthesia Care (MAC) ‐ conscious sedation Cardiovascular System 6502 Cardiac Surgical Coronary artery bypass valve replacement Heart transplant Non‐surgical ‐ Coronary angioplasty, coronary stent insertion, pacemaker insertion, AICD insertion and cardioversion Diagnostic Cardiac Catheterization Electrophysiologic studies Stress testing Transesophageal echocardiography Vascular Open surgical repair of aortic, subclavian and iliac artery aneurysms or occlusions and real artery bypass. Angioplasty (intravascular dilation technique) Endovascular stenting (placement of tube into blood vessel to open it) of any portion of the aorta, iliac or carotid artery or other (peripheral) arteries or veins Vascular thrombolysis (removal or dissolving of blood clots ‐ percutaneous (mechanical or chemical). Angiography with occlusion techniques (including embolization and sclerosis) ‐ therapeutic Mesenteric angiography with infusion therapy (Vasopressin) for gastrointestinal bleeding Inferior vena caval filter insertion & removal Pulmonary angiography Percutaneous treatment of pseudoaneurysm (percutaneous thrombin injection versus compression. Varicose vein treatment ‐ percutaneous via laser, RFA, chemical, w/o angiography Vascular access ‐ nontunneled catheters, tunneled catheters, implanted Digestive System Treatments and Procedures 6503 Cholecystectomy with or without common bile duct exploration Bariatric Surgery Pancreatectomy (subtotal or total) Total colectomy Subtotal colectomy Hepatobiliary drainage/intervention including percutaneous transhepatic cholangiography, percutaneous biliary drainage, percutaneous cholecystectomy, biliary stent placement (temp or perm), biliary stone removal/therapy Gastrointestinal tract stenting Ear Treatment and Procedures 6504 Stapedectomy Reconstruction of auricle of ear for congenital deformity or trauma Tympanoplasty with mastiodectomy Endocrine System Treatments and Procedures 6505 Thyroidectomy Parathyoidectomy Adrenalectomy See Pancreatectomy under subsection relating to digestive system Eye Treatments and Procedures 6506 Eye muscle surgery Surgery for cataract with or w/o implantation of intraocular lens. Retinal or vitreous surgery. Reconstructive and/or plastic surgical procedures of the eye and eye region, such as blepharoplasty, tumor, fracture. Lacrimal, foreign body, abscess or trauma Photocoagulation and/or cryotherapy Corneal surgery such as corneal transplant, refractive surgery & pterygium Glaucoma surgery by any method Removal of the eye or its contents (enucleation or evisceration) Surgery for penetrating ocular injury including intraocular foreign body Female Genital System Treatments and Procedures 6507 Abdominal hysterectomy (total) Vaginal hysterectomy All fallopian tub and ovarian surgery with or w/o hysterectomy including removal and lysis of adhesions Removing fibroids (uterine myomectomy) Uterine Suspension Removal of the nerves to the uterus (presacral neurectomy) Removal of cervix Repair of vaginal hernia (anterior and/or posterior colporrhaphy and/or enterocele repair) Abdominal suspension of the bladder (retropubic urethropexy) Conization of Cervix Dilation and Curettage of uterus (diagnostic/therapeutic) Surgical abortion/dilation and curettage/dilation and evacuation Medical abortion/non‐surgical Selective salpingography and Fallopian tube recanalization Fallopian tube occlusion (for sterilization) Hematic and Lymphatic System 6508 Transfusion of blood and blood components Splenectomy Integumentary System Treatments and Procedures 6509 Radical or modified radical mastectomy (simple mastectomy excluded) Reconstruction and/or plastic surgical operations of the face and neck Male Genital System 6510 Orchidopexy (reposition of testis) Orchiectomy (removal of testis) Vasectomy Maternity and Related Cases 6511 Delivery (vaginal) Delivery (cesarean) Cerclage Musculoskeletal System Treatments and Procedures 6512 Arthroplasty of any joints with mechanical device Arthroscopy of any joint Open reduction with internal fixation Osteotomy Ligamentous reconstruction of joints All other orthopedic procedures with children age 12 and under Vertebroplasty/kyphoplasty Nervous System Treatments and Procedures 6513 Craniotomy, craniectomy or cranioplasty Cranial nerve operations Spine operation including laminectomy, decompression, fusion, internal fixation or procedures for nerve root or spinal cord compression, diagnosis, pain, deformity, mechanical instability, injury, removal of tumor, abscess or hematoma (excluding coccygeal operations) Peripheral nerve operation, nerve grafts, decompression, transposition or tumor removal, neurorrhaphy, neurectomy or neruolysis Transphenoidal hypophysectomy or other pituitary gland operation Cerebral spinal fluid shunting procedure or revision Radiology 6514 Splenoportography (needle injection of contrast media in the spleen) Chemoembolization Radioembolization Thermal and other ablative techniques for treatment of tumors (for curative intent or palliation) including radiofrequency ablation, cryoablation and high intensity focused ultrasound (HIFU), irreversible electroporation TIPS (Transjugular Intrahepatic Portosystemic Shunt) and its variants such as DIPS (Direct Intrahepatic Portocaval Shunt) Myelography Percutaneous abscess/fluid collection drainage (percutaneous abscess/seroma/lymphocele drainage and/or sclerosis (including percutaneous transgluteal transrectal and trans vaginal routes) Procedures utilizing prolonged fluoroscopy Respiratory System Treatments and Procedures 6515 Biopsy and/or excision of lesion or larynx, vocal cords, trachea Rhinoplasty or nasal reconstruction with or without septoplasty. Submucous resection of nasal septum or nasal septoplasty Lung Biopsy Segmental resection of lung Thoracotomy Thoracotomy with drainage Open tracheostomy Respiratory tract/tracheobronchial balloon dilation/stenting Urinary System 6516 Partial nephrectomy (removal of part of the kidney) Radical nephrectomy (removal of kidney and adrenal gland for cancer Nephrectomy (removal of kidney) Nephrolithotomy and pyelolithotomy (removal of kidney stones) Pyeloureteroplasty (pyeloplasty or reconstruction of the kidney drains) Exploration of kidney or perinephric mass Ureteroplasty (reconstruction of ureter) Ureterolithotomy (surgical removal of stones from ureter Ureterectomy (partial or complete removal of ureter) Ureterolysis (partial/complete removal of ureter between kidney , bladder and adjacent tissue) Prostatectomy (partial or total replacement of prostate) Total cystectomy (removal of the urinary bladder). Radical cystectomy Partial cystectomy (partial removal of bladder) Urinary diversion (ileal conduit, conon conduit) Ureterosigmoidostomy (placement of kidney drainage tubes into the large bowel ‐ intestine Urethroplsty (construction/reconstruction of drainage tube from bladder. Percutaneous nephrostomy/stenting/stone removal Dialysis Hemodialysis Peritoneal dialysis Psychiatric Procedures Electroconvulsive therapy with modification by intravenous muscle relaxants and sedatives Radiation Therapy 6518 Head and neck Central nervous system Thorax Breast Abdomen Female pelvis Male pelvis Skin Extremities Total body irradiation Endoscopic Surgery 6519 Abdominal endoscopy/laparoscopy procedures (there are additional risks and hazards of the same surgery as when done an open procedure) Endoscopic surgery of the thorax (there are additional risks and hazards of the same surgery as when performed as an open procedure) Pain Management Procedures 6520 Neuroaxial procedures (injections into or around the spine) Peripheral and visceral nerve blocks and/or ablations Implantation of pain control devices.