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.

Ovarian Cyst, Resection of


Medical Codes

ICD-9-CM:
65.21 - Marsupialization of Ovarian Cyst
65.22 - Wedge Resection of Ovary
65.23 - Laparoscopic Marsupialization of Ovarian Cyst
65.24 - Laparoscopic Wedge Resection of Ovary
65.25 - Other Laparoscopic Local Excision or Destruction of Ovary
65.29 - Other Local Excision or Destruction of Ovary; Bisection of Ovary; Cauterization of Ovary; Partial Excision of Ovary

Related Terms

  • Ovarian Cystectomy

Overview

A resection of an ovarian cyst is the surgical removal (excision) of a sac filled with a collection of fluid or semi-solid material (cyst) within ovarian tissue without removing the ovary.

Eggs within the ovary are surrounded by specialized cells that assist in the process of egg maturation and release (ovulation). The egg with its surrounding cells is called an ovarian follicle, and cysts that developed from ovarian follicles are called follicular cysts. The follicular remnant after release of an egg (corpus luteum) also can develop into a cyst (corpus luteum cyst). At times, the cells of the follicle or corpus luteum produce excess fluid, which creates cysts. Ovarian cysts can develop from uterine tissue (endometrial cysts, endometriomas) that has been spontaneously transplanted onto the ovary (endometriosis); from tissues such as skin, hair, or teeth originating from the ectoderm, the outermost cell layer of the very early embryo (dermoid cysts); or as the result of an endocrine disorder (polycystic ovary syndrome).

Ovarian cysts are very common and usually are noncancerous (benign). Most resolve on their own without surgery.

Source: Medical Disability Advisor



Reason for Procedure

Resection of an ovarian cyst is done to remove symptomatic benign cysts of the ovary that do not resolve over several menstrual cycles, do not respond to treatment, are suspiciously large, cause pain or heavy bleeding, or are contributing to fertility problems. Ovarian cysts also may be removed to sample ovarian tissue (biopsy) to rule out ovarian cancer. Resection, as opposed to ovary removal (oophorectomy), usually is done in younger women who wish to retain their ability to have children.

Source: Medical Disability Advisor



How Procedure is Performed

An ovarian cyst resection usually is done by laparoscopy. For laparoscopy, the abdominal cavity is inflated with carbon dioxide gas (pneumoperitoneum) to allow visualization within the abdomen and provide an open workspace. Gas is introduced into the abdominal cavity through a needle (Veress needle). One or more small incisions are made into the abdominal cavity, and needle-like tubes (trocars) are inserted. Once the laparoscope has been inserted through a trocar, the abdominal cavity can be viewed on a video screen. The surgeon uses small instruments, either attached to the laparoscope or inserted through other trocars, to perform the surgery. The cyst is dissected from healthy ovarian tissue and removed intact, often via a collapsible laparoscopic bag to avoid the risk of material spillage. Laparoscopic removal of a large ovarian cyst may be assisted by making a vaginal incision (colpotomy) to insert a trocar through which the cyst is drained (aspirated) before removal. Laparoscopically assisted transvaginal ovarian cystectomy reduces spillage of cyst contents into the peritoneal cavity and enables shorter operative times (Nezhat).

Ovarian cysts also may be excised by traditional open surgery (laparotomy), in which a large incision is made horizontally or vertically into the abdomen to expose the ovary and dissect away the cyst. Before suturing the abdomen closed, the abdominal cavity is washed (irrigated) to remove any cyst contents that might have spilled.

A third procedure to excise ovarian cysts is colpotomy. With colpotomy, the only incision is made into the vaginal wall. The cyst may be drained before removal, and along with its shell (capsule), it is gently peeled away from the ovarian tissue. Bleeding (hemorrhage) may need to be controlled by application of electric current (electrocauterization) or by laser. At the discretion of the surgeon, the ovarian incision may be either sutured closed or left open. It should be noted that colpotomy has almost completely been replaced by laparoscopy due to its limited visualization and increased risk of postoperative infection.

The method used largely depends upon the expertise of the surgeon and the size of the cyst. A laparoscopy is more technically difficult but reduces the incidence of certain complications (e.g., cutting the intestines). A laparotomy would likely be indicated for individuals with a very large cyst or for those with internal scar tissue (adhesions), which increases the risk of cutting the intestines. In general, laparoscopy and colpotomy are performed on an outpatient basis, and laparotomy is performed as an inpatient procedure. All are done under general or regional (epidural) anesthesia. The excised cyst is examined microscopically to make sure it is benign.

Source: Medical Disability Advisor



Prognosis

Regardless of the surgical procedure, most cysts can be completely excised without complications, and a thorough recovery can be expected.

Source: Medical Disability Advisor



Specialists

  • Gynecologist
  • Pathologist
  • Radiologist

Source: Medical Disability Advisor



Comorbid Conditions

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Complications

The Veress needle or trocar can cut major abdominal or pelvic blood vessels or injure the intestines, bladder, or ureters. Rarely, the intestine may protrude from the incisions (herniate). Hemorrhage, infection, and blood clots (thromboembolism) are possible complications of any gynecological surgical procedure. Abdominal surgery can lead to formation of adhesions, which can cause pain, constriction of the intestines, and infertility. After ovarian cystectomy, 53% of women develop fewer follicles and have reduced ovulation from the affected ovary (Takahashi).

Source: Medical Disability Advisor



Factors Influencing Duration

Recovery time depends on whether a laparoscopic or open (laparotomy) surgical technique is used and whether any complications develop. Women who have a laparoscopy usually have a shorter disability than those who have a laparotomy.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Normal activities are encouraged as soon as a woman is able, but they may cause fatigue, so frequent rest breaks may be necessary. Strenuous physical activities (e.g., heavy lifting, walking long distances, going up and down stairs, carrying heavy objects) may temporarily need to be restricted following ovarian cyst resection. With laparoscopy, most activities may be resumed within 2 to 4 weeks ("Ovarian Cystectomy"). Women who have a laparotomy may be temporarily unable to drive a car or other motor vehicle and will require longer recovery time. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

Source: Medical Disability Advisor



References

Cited

Chohan, Naina D., et al., eds. "Ovarian Cystectomy." Nurse’s 5-Minute Clinical Consult: Treatments. 1st ed. Lippincott, Williams & Wilkins, 2007. 264-265.

Jocoy, Sandy. "Surgery for Ovarian Cysts." WebMD. Ed. Kathleen M. Ariss. 10 Nov. 2008. 29 Jul. 2009 <http://women.webmd.com/surgery-for-ovarian-cysts>.

Nezhat, Camran, Ceana Nezhat, and Farr Nezhat. "Section 9.2.: Ovarian Cystectomy." Nezhat’s Operative Gynecologic Laparoscopy with Hysteroscopy. Eds. Camran Nezhat, Farr Nezhat, and Ceana Nezhat. 3rd ed. Cambridge University Press, 2008. 187-197.

Takahashi, Kentaro, et al. "Influence of Ovarian Cystectomy on the Ovalatory Function of the Residual Ovary (abstract)." European Journal of Obstetrics Gyndcology & Reproductive Biology 121 2 (2005): 191-194. PubMed. <http://www.ncbi.nlm.nih.gov/pubmed/16054961>.

Source: Medical Disability Advisor