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.

Nephrectomy


Related Terms

  • Excision of Kidney
  • Partial Nephrectomy
  • Radical Nephrectomy
  • Simple Nephrectomy

Specialists

  • General Surgeon

Comorbid Conditions

Factors Influencing Duration

The reason for the surgery, the type of surgery, and any complications may influence the length of disability.

Medical Codes

ICD-9-CM:
17.42 - Laparoscopic Robotic Assisted Procedure; Robotic Assistance in Laparoscopic Procedure
17.49 - Other and Unspecified Robotic Assisted Procedure; Robotic Assistance in Other and Unspecified Procedure
55.4 - Nephrectomy, Partial; Calycectomy; Wedge Resection of Kidney
55.51 - Nephroureterectomy; Nephroureterectomy with Bladder Cuff; Total Nephrectomy (Unilateral)
55.52 - Nephrectomy of Remaining Kidney; Removal of Solitary Kidney
55.54 - Bilateral Nephrectomy

Overview

Nephrectomy is the surgical removal of a kidney. The three basic groups of nephrectomies are simple, partial, and radical. Simple nephrectomy removes the kidney along with a small section of the tube that connects the kidney to the bladder (ureter). In a partial nephrectomy, only that portion of the kidney that is diseased is removed. A radical nephrectomy removes the kidney, surrounding fat, fascia, lymph nodes, and two-thirds of the ureter. The operations can be done with incisions through the side (flank), back (dorsal), or abdomen. Laparoscopic nephrectomy is increasingly used as an alternative to conventional nephrectomy in selected cases.

Radical nephrectomies are performed for cancers of the kidney. Simple nephrectomies are performed for severe hereditary deformities of the kidney or any type of acquired condition that damages the kidney and impairs its function. When a kidney is removed, the remaining healthy kidney enlarges and takes over the function of the removed kidney. If both kidneys are removed, dialysis is required to provide kidney function unless a healthy kidney can be transplanted into the individual.

The majority of nephrectomies are performed for the treatment of renal cell carcinoma (hypernephroma).

The other frequent indication for nephrectomy is to harvest the organ when a kidney is donated by a healthy individual for a kidney transplantation.

Source: Medical Disability Advisor



Reason for Procedure

Simple nephrectomy is performed for severe enlargement of the kidney due to obstruction (chronic hydronephrosis); an underdeveloped, poorly functioning kidney (hypoplasia); a diseased kidney causing severe high blood pressure (renovascular hypertension); large, obstructive kidney stones (calculi), and donation of a kidney for transplant. Partial nephrectomy is performed for small tumors of the kidney, both benign and malignant. Radical nephrectomy is performed for cancer of the kidney (renal cell carcinoma) and renal pelvis.

Source: Medical Disability Advisor



How Procedure is Performed

Nephrectomies are done as inpatient procedures under general anesthesia. A simple nephrectomy results in removal of the kidney and a small section of the tube that connects the kidney to the bladder (ureter). In a partial nephrectomy, only the diseased portion of kidney is removed. In a radical nephrectomy, the entire kidney is removed, along with surrounding fat, fascia, lymph nodes, and two-thirds of the ureter. The kidney remains intact and undisturbed during the procedure as minimal palpation decreases the risk of cancer spread.

The three procedures may be done by any of five basic surgical approaches including extraperitoneal flank, dorsal lumbotomy, abdominal, thoracoabdominal, and laparoscopy. Careful preoperative evaluation and planning is necessary due to the numerous surgical approaches available and their specific risks and complications.

In all procedures and approaches, the surgeon makes a skin incision followed by incision and retraction of the deeper structures, such as fascia and muscle.

The extraperitoneal flank approach involves placing the individual on his or her side with the middle of the table elevated. This position is particularly useful for the obese individual but cannot be used for individuals with scoliosis or cardiorespiratory problems. The incision is located over the eleventh or twelfth rib, and the rib is removed to expose the kidney.

The dorsal lumbotomy approach is done with the individual lying face down (prone) with the incision done on the back. This approach has the advantages of not having to cut muscle or remove a rib. It is useful for removing small kidneys and affords exposure for the removal of both kidneys (bilateral excision).

The abdominal approach is done with the individual on his or her back (supine position). It involves making an incision over the abdomen and moving (retracting) the abdominal organs. Its primary advantage is better exposure of the portion of the kidney known as the renal pedicle (renal artery and vein), although there are more potential complications, especially those common in abdominal surgery (ileus, adhesions).

The thoracoabdominal approach involves a long incision on the chest and abdomen with the individual on his side. This incision is useful for radical nephrectomy. It has similar disadvantages to the abdominal approach and can result in pulmonary complications such as pneumothorax and atelectasis. In the abdominal and thoracoabdominal incisions, the abdominal organs (viscera) must be moved out of the way (retracted) to expose the kidney.

The kidney is exposed, and the surgeon cuts (incises) the connective tissue enclosing it (Gerota's fascia). The artery and vein to the kidney (renal artery and vein) are identified, clamped, cut, tied, and divided. The ureter is then identified, clamped, cut, tied, and divided. The kidney is removed and sent to the laboratory for examination (pathologic examination). The surgeon uses sutures to repair fascial tissue and muscle cut as part of the operation. The skin incision is closed with sutures or staples. A plastic tube or rubber drain is inserted into the wound through a separate stab incision to allow drainage of the wound and prevent hematoma formation. A dressing is applied. In radical nephrectomy, the tissue surrounding the opened kidney remains untouched and Gerota's fascia is not opened. The kidney and its attached fat and fascia are removed intact (en bloc).

In a laparoscopic nephrectomy, a laparoscope and small surgical instruments are inserted into the abdomen through four small incisions. A tiny camera on the laparoscope guides the surgical instruments in freeing the kidney. One of the small incisions, usually the one located just below the navel, is enlarged to allow the kidney to be lifted out of the body. Because laparoscopic surgery is less invasive than standard surgery, it has many advantages, including a smaller incision, better cosmetic results, a faster recovery time, and a shorter hospital stay. Disadvantages include longer operating times and the need for a surgeon who is skilled in laparoscopy. Rates of complications are similar to those for standard nephrectomies.

Source: Medical Disability Advisor



Prognosis

The prognosis after a nephrectomy for kidney cancer frequently depends on whether the cancer has already spread to distant organs. For individuals with metastic cancer, the 5-year survival rate is lower than 10%. In individuals whose cancerous lesions have been removed with a radical nephrectomy, there is a 20% to 30% chance of relapse. The operative mortality rate for radical nephrectomy is about 2% (Narain).

Source: Medical Disability Advisor



Complications

Complications of nephrectomy include infection, excessive bleeding (hemorrhage), urinary fistula formation, renal failure, ileus, pneumothorax, pneumonia, cerebrovascular accident, pulmonary embolism, atelectasis, and adhesions. An estimated 20% of individuals who have a radical nephrectomy develop complications (Narain).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Heavy lifting, carrying, pushing, and pulling may need to be restricted. Individuals need time off to recuperate from the surgery.

Source: Medical Disability Advisor



References

Cited

Narain, Vivek. "Nephrectomy, Radical." eMedicine. 5 Mar. 2004. Medscape. 16 May 2005 <http://emedicine.com/med/topic3062.htm>.

Source: Medical Disability Advisor






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