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.

Myomectomy, Uterine


Related Terms

  • Uterine Fibroidectomy

Specialists

  • Obstetrician/Gynecologist

Comorbid Conditions

  • Sarcoma

Factors Influencing Duration

Length of disability may be influenced by the type of myomectomy procedure performed (laparoscopy, hysteroscopy, or laparotomy); the size, location, and number of leiomyomas removed; and the presence of complications (excessive bleeding, postoperative infection, or conversion to hysterectomy).

Medical Codes

ICD-9-CM:
68.29 - Excision or Destruction of Lesion of Uterus; Uterine Myomectomy

Overview

Myomectomy is the surgical removal of uterine fibroids while preserving the uterus. Uterine fibroids (leiomyomas) are benign tumors of the uterine muscle. Fibroids are classified by location in the uterus: those that grow into the uterine cavity are called submucosal fibroids, those located in the uterine wall are called intramural fibroids, and those that protrude outside the uterine wall are called subserosal fibroids.

Myomectomy may be performed to preserve the individual's fertility while removing symptomatic uterine fibroids that cause excessive uterine bleeding, pelvic discomfort, low back pain, or chronic constipation or urinary tract compression (Marquard).

Several approaches are available for myomectomy, including abdominal myomectomy, laparoscopic myomectomy, and myomectomy performed through the woman's cervical canal, which does not involve abdominal incisions (hysteroscopic myomectomy).

Source: Medical Disability Advisor



Reason for Procedure

Uterine fibroids are benign, estrogen-dependent tumors, which typically begin as microscopic whorls of fibrous tissue and grow very slowly for as long as estrogen is present. Usually they are multiple. They typically regress in size after menopause, more slowly if the patient takes replacement hormones.

Uterine fibroids often cause no symptoms at all, in which case the fibroids require no treatment. However, in some cases, uterine fibroids cause infertility, miscarriage, pelvic pain, excessive bleeding, abdominal distension, and urinary and gastrointestinal problems. When symptomatic, uterine fibroids require treatment.

Uterine fibroids can be treated medically (with drugs that interfere with the production of gonadotropins) or surgically (with myomectomy or hysterectomy). Because a myomectomy removes just the tumors and not the entire uterus (hysterectomy), myomectomy is indicated when the individual wishes to retain the ability to have children (fertility) and wants to keep her uterus. A myomectomy may permit shorter hospital stays, shorter recovery time, less bleeding, and less scar tissue formation (adhesions) than a hysterectomy.

Source: Medical Disability Advisor



How Procedure is Performed

Depending on the location of the fibroids, myomectomy can be accomplished by either an abdominal or vaginal approach. In the presence of large fibroids in the uterine wall (intramural) or bulging out of the uterus (subserosal), an open abdominal approach (laparotomy) is normally used. Performed under general anesthesia, the procedure involves an incision into the abdominal cavity. The tumors, which have previously been located by ultrasound, are removed from the uterus, and the uterine wall and abdominal incision are sewn up (sutured).

In laparoscopic myomectomy, a viewing instrument (laparoscope) is inserted into the abdomen through a small incision in the abdominal wall. This device allows small surgical instruments to be passed through the scope for removal of the tumors. Laparoscopic myomectomy is typically indicated for fibroids that are attached to the outside of the uterus by a stalk (pedunculated). Typically, a laparoscopy requires a smaller incision and a shorter recovery time than a laparotomy. In some cases, minimally invasive laparoscopic myomectomy is performed with robotic assistance to remove uterine fibroids precisely and cause less tissue damage when repairing the uterine wall.

If the fibroids are small and bulging into the uterine cavity (submucosal), a vaginal approach (hysteroscopic resection) is normally used. A resectoscope (a type of hysteroscope) is inserted into the uterus via the vagina, the fibroids are identified and removed, and the uterine wall is repaired.

Source: Medical Disability Advisor



Prognosis

Myomectomy is a safe and effective alternative to hysterectomy. Myomectomy performed via the laparoscopic approach is more successful than an open incision (laparotomy) for removing symptomatic fibroids while preserving the individual’s fertility (Palomba). Following a successful myomectomy, up to 80% of women achieve resolution of all symptoms related to fibroids ("Myomectomy"). However, fibroids that were microscopic at the time of surgery may grow under the continued influence of female hormones, and the situation may return to the pre-surgery stage.

Following myomectomy, the risk of an individual requiring a second surgery is 21.8%, with an incidence of nearly 5% per year (Reed).

Recovery time varies greatly for individuals; a woman typically returns to work after 2 to 6 weeks. Heavy lifting needs to be temporarily modified or avoided for 4 weeks. Following open abdominal myomectomy, the individual may require 4 to 6 weeks of recovery time, similar to other abdominal surgeries ("Myomectomy").

Following myomectomy via laparoscopy, recovery is faster, usually within 2 to 3 weeks ("Myomectomy").

Source: Medical Disability Advisor



Rehabilitation

Short walks should be implemented as soon as possible following surgery to help avoid blood clots in the legs. A normal diet should be resumed as soon as normal bowel function returns.

Source: Medical Disability Advisor



Complications

Critical to the success of the myomectomy procedure is the reconstruction of the uterus after fibroid removal. The primary complications that may arise from uterine myomectomy include postoperative bleeding and infection; the risk of excessive bleeding increases if there were many large fibroids in different areas of the uterus that required numerous incisions. Following abdominal myomectomy, the risk of blood loss significant enough to require transfusion is 28% (Iverson); however, the risk of blood loss and other complications such as infection and injury to abdominal organs is less than with hysterectomy.

With laparoscopic myomectomy, the rate of postoperative complications is 5.7%, and intra-operative complications occur in 2.6% of individuals (Altgassen). One intra-operative complication of a myomectomy is the potential to convert the procedure into a hysterectomy. This may be necessary because of the state of the uterus once the fibroids have been removed or because of excessive bleeding; this occurs in between 0.7% and 1.9% of laparoscopic myomectomy surgeries (Marquard).

Complications of hysteroscopic myomectomy include uterine perforation and excessive absorption into the bloodstream of the fluid used to distend and irrigate the uterine cavity, which may result in fluid imbalances, cerebral or pulmonary edema, or, in rare cases, heart failure and death (Marquard). With hysteroscopic myomectomy, the rate of intra-operative complications ranges from 0.3% to 2.8% (Sardo).

Other complications include postoperative adhesion formation and intra-operative damage to the fallopian tubes, bowel, or ureter. A reconstructed uterus could rupture during future pregnancy or delivery. For this reason, in future pregnancies the reconstructed uterus is treated as though it had previously undergone a classical (vertical) cesarean section, and a planned cesarean without labor is expected.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Since hysteroscopic myomectomy is usually performed on an outpatient basis, a 2- to 3-day recovery period at home may be required before resumption of full activity after approximately 1 week (“Myomectomy”).

Source: Medical Disability Advisor



References

Cited

"Myomectomy." MayoClinic.com. 21 Apr. 2009. Mayo Foundation for Medical Education and Research. 13 Jul. 2009 <http://www.mayoclinic.com/health/myomectomy/MY00501/DSECTION=what-you-can-expect>.

Altgassen, C., et al. "Complications in Laparoscopic Myomectomy." Surgical Endoscopy 20 4 (2006): 614-618.

Iverson, R. E., et al. "Relative Morbidity of Abdominal Hysterectomy and Myomectomy for Management of Uterine Leiomyomas." Obstetrics and Gynecology 88 3 (1996): 415-419.

Marquard, Kerri L., David Chelmow, and Edward G. Evantash. "Gynecologic Myomectomy." eMedicine. Eds. Thomas Michael Price, et al. 6 Aug. 2008. Medscape. 13 Jul. 2009 <http://emedicine.medscape.com/article/267677-overview>.

Palomba, S., et al. "A Multicenter Randomized, Controlled Study Comparing Laparoscopic Versus Minilaparotomic Myomectomy: Reproductive Outcomes." Fertility and Sterility 88 4 (2007): 933-941.

Reed, S. D., et al. "The Incidence of Repeat Uterine Surgery Following Myomectomy." Journal of Women's Health 15 9 (2006): 1046-1052.

Sardo, A. D. S., et al. "Hysteroscopic Myomectomy: A Comprehensive Review of Surgical Techniques." Human Reproduction Update 14 2 (2008): 101-119.

Source: Medical Disability Advisor






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