Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Laparoscopy


Related Terms

  • Peritoneoscopy

Specialists

  • General Surgeon
  • Gynecologist

Comorbid Conditions

Factors Influencing Duration

When laparoscopy is performed as a diagnostic procedure, the underlying reason for laparoscopic examination will influence the length of disability. In laparoscopic surgery, the underlying cause and the complexity of the surgical procedure will determine duration.

Medical Codes

ICD-9-CM:
54.21 - Laparoscopy; Peritoneoscopy

Overview

© Reed Group
Laparoscopy is an endoscopic technique using a laparoscope that allows direct visualization of the abdominal or peritoneal cavity, including the abdominal wall; the stomach, intestines, gallbladder, liver, and kidneys; and the female reproductive organs such as the ovaries, fallopian tubes, and uterus (gynecologic examination). A laparoscope is a tubular fiberoptic instrument that has a miniaturized telescope at one end and a light source that illuminates the inside of the abdomen. Light and images are conducted by fine synthetic fibers contained in the length of the laparoscope. Laparoscopy can be used for abdominal examination only or to perform minimally invasive surgical procedures instead of open surgery. It is often used for gynecologic examination and surgery, and is used increasingly as a less invasive alternative for simpler abdominal surgeries.

Other surgeries that can be performed laparoscopically include hernia repair; gastric bypass (for obesity); removal of the appendix, gallbladder, or spleen; and treatment of colon cancer. A newer treatment using the laparoscope is laparoscopic antireflux surgery (LARS) for individuals with gastroesophageal reflux disease (GERD); it is performed to relieve esophageal sphincter pressure.

Robotic laparoscopy procedures can be performed using a robotic arm attached to the operating table to hold and position the instrument. The robotic arm is controlled by the surgeon via a pedal, voice-activated command, or handheld control panel. The technique improves visualization by keeping the laparoscope steady.

Microlaparoscopy is also becoming more common. It features the use of smaller laparoscopes and allows the patient to receive local anesthesia or sedation rather than general anesthesia. It also allows selected procedures to be performed in a physician's office.

Laparoscopic radiofrequency ablation is a technique used to destroy malignant tumor cells and help prevent the spread (metastasis) of the cancer. It is based on introducing radiofrequency probes through the laparoscope to deliver pulses to the tumor site.

Other advances expected to expand the usefulness of laparoscopic procedures include temperature-controlled instruments, greater rotation of instruments, improved imaging systems, and improved robotics.

Source: Medical Disability Advisor



Reason for Procedure

A laparoscopy is indicated in any situation in which internal examination of the abdomen will help establish a diagnosis and determine subsequent treatment and when a minimally invasive procedure is preferable to open exploratory surgery. Individuals undergoing this procedure, as with open procedures, will have a complete preoperative evaluation prior to the surgical procedure.

Laparoscopy can be both diagnostic and operative. A diagnostic or exploratory laparoscopy is performed to determine the cause of abdominal or pelvic pain, such as severe menstrual pain, or to investigate a mass that was palpable on physical examination. Laparoscopy is also used to diagnose or rule out infertility.

An operative laparoscopy (laparoscopic surgery) may be used to remove abdominal or scar tissue (pelvic adhesions); to treat ectopic (tubal) pregnancy or endometriosis; or to perform other gynecologic procedures, such as the removal of ovarian cysts or the entire ovary, uterine fibroids, or the uterus (hysterectomy). Laparoscopy is also used worldwide for female sterilization, the management of pelvic pain, and the treatment of pelvic infection (Katz). The practice of gynecology was revolutionized by the advent of fiber optics and laparoscopy in the twentieth century; recent advances in laparoscopic techniques have improved gynecologic diagnosis and surgical treatment further, resulting in less morbidity, easier recovery, and shorter hospital stays for patients (Katz). Laparoscopy is rapidly becoming the most common surgical procedure for performing a liver biopsy, removing the gall bladder when gallstones are symptomatic (cholecystectomy), removing the vermiform appendix (appendectomy), treating colon pathology, and performing many other abdominal surgeries.

Laparoscopy is also frequently used to assess blunt or penetrating trauma and as a follow-up examination after cancer surgery.

Source: Medical Disability Advisor



How Procedure is Performed

Laparoscopy is most often performed under general anesthesia in an operating room, although certain laparoscopic procedures can be performed using local or regional anesthesia. Prior to the procedure, a urinary catheter is passed into the patient’s bladder to collect urine while the abdominal cavity is being explored or surgery is being performed. A small incision is made near the navel, and a cannula is inserted to keep the incision open. The laparoscope is introduced through the cannula, and the abdominal cavity is filled with carbon dioxide to distend the abdomen, lift the abdominal wall away from underlying organs, and separate abdominal organs, generally improving visibility for the surgeon (insufflation).

The laparoscope has a built-in camera that transmits images while the procedure is performed. The entire procedure is viewed on a video monitor over the operating table, allowing the laparoscope to be guided visually to examine organs of interest and surrounding tissues.

Abnormal growths or tissues may be biopsied or excised through another small incision that allows passage of a needle for needle biopsy or a tiny scalpel for removal of cysts (especially ovarian cysts), polyps, or small tumors or, in more complex surgeries, organ treatment or removal. Robotic laparoscopy may be used to steady the laparoscope, which improves visualization of the procedure.

A simple diagnostic laparoscopy usually takes about 10 to 15 minutes. Operative laparoscopy can take several hours, depending on the procedure being performed. Still photographs or a videotape of the procedure are taken to include in the medical record.

After the instruments have been removed and the carbon dioxide gas has been released, dissolvable stitches are used to close each incision site. After complex surgery, a thin drain tube (catheter) may be left in the abdominal wall for 24 hours to remove excess fluid and also to allow examination of the fluid for bleeding or possible infection in the surgical site.

Source: Medical Disability Advisor



Prognosis

The outcome depends on the severity of any condition or disease discovered or treated during the procedure. Generally, the prognosis is good with this less invasive procedure. Morbidity, hospital stays, and recovery period are shown to be reduced with laparoscopic surgeries (Katz). In a long-term study comparing laparoscopy to laparotomy for treating endometrial cancer, investigators concluded that laparoscopic surgery is as safe and effective a procedure as laparotomy (Zullo).

Source: Medical Disability Advisor



Complications

Complications are rare. However, the most common complications are cardiac and respiratory problems resulting from insufflation or anesthesia. Other complications common to open surgical procedures include vascular damage and related bleeding, tissue damage, and blood vessel damage (bowel or urologic injury). Injury to the intestines will require another surgical procedure to repair the injury. When general anesthesia is required, reaction to the anesthesia is a possible complication. Infection is a possible complication with any surgical procedure.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Unless complications are present, no work restrictions or special accommodations are required.

Source: Medical Disability Advisor



References

Cited

Katz, Vern L., et al., eds. "Laparoscopy." Comprehensive Gynecology. 5th ed. Mosby, Inc., 2007.

Zullo, Fulvio, et al. "Laparoscopic Surgery Vs. Laparotomy for Early Stage Endometrial Cancer: Long-Term Data of a Randomized Controlled Trial." American Journal of Obstetrics and Gynecology 200 3 (2009): E1-9.

General

"Laparoscopy." Georgia Reproductive Specialists. 2007. 7 Sep. 2009 <http://www.ivf.com/laprscpy.html>.

Source: Medical Disability Advisor






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