• Title/Summary/Keyword: 수술 계획

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Is a Fast-track Critical Pathway Possible in Gastric Cancer Surgery? (위암 수술 후 조기회복을 위한 임상진료 지침서의 활용이 가능한가?)

  • Yi, Jeong-Min;Hur, Hoon;Kim, Sung-Keun;Song, Kyo-Young;Chin, Hyung-Min;Kim, Wook;Park, Cho-Hyun;Park, Seung-Man;Lim, Keun-Woo;Jeon, Hae-Myung
    • Journal of Gastric Cancer
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    • v.9 no.1
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    • pp.18-25
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    • 2009
  • Purpose: The postoperative hospital stay after gastric cancer surgery is usually 8 to 14 days. The main reason for a prolonged hospital stay may be the 3 to 4 day period of postoperative starvation. The aim of this study is to investigate the feasibility of a critical pathway for early recovery after gastric cancer surgery, and this pathway included early postoperative feeding. Materials and Methods: One hundred three consecutive patients who underwent gastric resection and reconstruction for gastric cancer from October 2007 to June 2008 at St. Mary's Hospital were prospectively enrolled in a fast-track critical pathway. The pathway included minimal preoperative procedures, optimal pain relief, proper fluid administration, early mobilization and early enteral nutrition at postoperative 1 day. The exclusion criteria were determined preoperatively, intraoperatively and postoperatively. Results: Of the 103 patients, 19 patients were excluded for preoperative (5), intraoperative (7) and postoperative (7) reasons. Eighty-four patients (81.6%) were included in the fast-track critical pathway. Sixty-eight (88.6%) of 84 patients were discharged at the planned 8 day after surgery during the initial period of the study, and the postoperative hospital stay was shortened up to 6 days during the more recent period. Postoperative complications occurred in 22 patients (26.2%), and these were gastrointestinal track-related complications in 6 cases (3 cases of ileus, 1 case of stasis and 2 cases of leakage) and infection-related complications in 8 cases. There was no statistical difference in the incidence of morbidity according to the clinic-operative features that included age, gender, stomach resection and lymphadenectomy. Conclusion: The fast-track critical pathway with using the available exclusion criteria was a valid option for patients who underwent gastric cancer surgery.

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Accuracy assessment of implant placement using a stereolithographic surgical guide made with digital scan (디지털 스캔을 이용하여 제작된 임플란트 수술가이드의 정확도)

  • Jeong, Seung-Mi;Fang, Jeong-Whan;Hwang, Chan-Hyeon;Kang, Se-Ha;Choi, Byung-Ho;Fang, Yiqin;Jeon, Hyongtae;An, Sunghun
    • The Journal of Korean Academy of Prosthodontics
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    • v.53 no.2
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    • pp.111-119
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    • 2015
  • Purpose: The objective of this study was to evaluate the accuracy of a stereolithographic surgical guide that was made with information from intraoral digital impressions and cone beam CT (CBCT). Materials and methods: Six sets of resin maxilla and mandible models with missing teeth were used in this study. Intraoral digital impressions were made. The virtual models provided by these intraoral digital impressions and by the CBCT scan images of the resin models were used to create a surgical guide. Implant surgery was performed on the resin models using the surgical guide. After implant placement, the models were subjected to another CBCT scan to compare the planned and actual implant positions. Deviations in position, depth and axis between the planned and actual positions were measured for each implant. Results: The mean deviation of the insertion point and angulation were 0.28 mm and $0.26^{\circ}$, apex point were 0.11 mm and 0.14 mm respectively. The implants were situated at a mean of 0.44 mm coronal to the planned vertical position. Conclusion: This study demonstrates that stereolithographic surgical guides created without the use of impressions and stone models show promising accuracy in implant placement.

A Study on Dose Distribution Programs in Gamma Knife Stereotactic Radiosurgery (감마나이프 방사선 수술 치료계획에서 선량분포 계산 프로그램에 관한 연구)

  • 고영은;이동준;권수일
    • Progress in Medical Physics
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    • v.9 no.3
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    • pp.175-184
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    • 1998
  • The dose distribution evaluation program for the stereotactic radiosurgery treatment planning system using a gamma knife has been built in order to work on PC. And this custom-made dose distribution is compared with that of commercial treatment planning program. 201 source position of a radiation unit were determined manually using a gamma knife collimator draft and geometrical coordinates. Dose evaluation algorithm was modified for our purpose from the original KULA, a commercial treatment planning program. With the composed program, dose distribution at the center of a spherical phantom, 80 mm in diameter, was evaluated into axial, coronal and sagittal image per each collimator. Along with this evaluated data, the dose distribution at a arbitrary point of inside the phantom was compared with those from KULA. Radiochromic film was set up at the center of the phantom and was irradiated by gamma knife, for the verification of dose distribution. In result, the deviation of the dose distribution from that of KULA is less than ${\pm}$3%, which is equivalent to ${\pm}$0.3 mm in 50% isodose distribution for all examined coordinates and film verification. The custom-made program, GPl is proven to be a good tool for the stereotactic radiosurgery treatment planning program.

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Development of a Stereotactic Radiosurgery Planning System (뇌정위 방사선수술을 위한 컴퓨터 치료계획시스템의 개발)

  • 조병철;오도훈;배훈식
    • Progress in Medical Physics
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    • v.8 no.1
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    • pp.17-24
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    • 1997
  • We developed PC-based planning system for linear accelerator based stereotactic radiosurgery. The system was developed under Windows 95 on Pentium Pro$\^$(R) 200 ㎒ IBM PC with 128 MB RAM. It was programed using IDL$\^$(R)/ of Research Systems, Inc. as a programing tool. CT image data obtained with BRW stereotactic frame is transferred to PC through magnetoptical disk. As loading the image, the system automatically recognizes the location of rods and establishes stereotactic coordinates. It accurately calculates and corrects the coordinates, degree of tilting, and magnification rate of axial images. After the coordinates is defined we can delineate and edit the contours of target and organs of interest on axial images. Upon delineating contours of target, isocenter is determined automatically and we can set up the beam configuration for radiosurgery. The system provides beam's eye view and room's eye view for efficient confuguring of beams. The system calculates dose distribution 3-dimensionally. It takes 1 to 2 minutes to calculate dose distribution for 5 arcs. We can verify the dose distribution on serial axial images. We can analyze the dose distribution quantitatively by evaluation of dose-volume histogram of target and organ of interest. This system, PC-based radiosurgery planning system, includes the basic features for radiosurgery planning and calculates dose distribution within reasonable time for clinical application.

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Dosimetry and Three Dimensional Planning for Stereotactic Radiosurgery with SIEMENS 6-MV LINAC (6-MV선형가속기를 이용한 입체방사선수술의 선량측정 및 3차원적 치료계획)

  • Choi Dong-Rak;Cho Byong Chul;Suh Tae-Suk;Chung Su Mi;Choi Il Bong;Shinn Kyung Sub
    • Radiation Oncology Journal
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    • v.11 no.1
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    • pp.175-181
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    • 1993
  • Radiosurgery requires integral procedure where special devices and computer systems are needed for localization, dose planning and treatment. The aim of this work is to verify the overall mechanical accuracy of our LINAC and develop dose calculation algorithm for LINAC radiosurgery. The alignment of treatment machine and the performance testing of the entire system were extensively carried out and the basic data such as percent depth dose, off-axis ratio and output factor were measured. A three dimensional treatment planning system for stereotactic radiosurgery has been developed. We used an IBM personal computer with C programming language (IBM personal system/2, Model 80386, IBM Co., USA) for calculating the dose distribution. As a result, deviations at isocenter on gantry and table rotation for our treatment machine were acceptable since they were less than 2 mm. According to the phantom experiments, the focusing isocenter were successful by the error of less than 2 mm. Finally, the mechanical accuracy of our three dimensional planning system was confirmed by film dosimetry in sphere phantom.

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Application of digital implant system on implant treatment with "all-on-4" concept (디지털 임플란트 시스템을 전용한 "All-on-4" 개념의 임플란트 보철 증례)

  • Kim, Yong-Jun;Jeong, Seung-Mi;Kim, Kyeong-Hee;Fang, Jeong-Whan;Kim, Dae-Hwan;Choi, Byung-Ho
    • The Journal of Korean Academy of Prosthodontics
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    • v.56 no.1
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    • pp.88-94
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    • 2018
  • Recently, digital implant systems are expanding its influence in dental area. Due to technical improvement, they jumped over their limits nowadays. We can use these newest systems to treat edentulous patient, from implant surgery to fabrication of prosthesis. In this case, The patient was a fifty years old female. She had a full edentulous ridge on mandible and wanted to reconstruct occlusion with using implants. We planned to use digital implant system with "all-on-4" concept on mandible and produced surgical guide for flapless implant surgery. After the surgery, we tried to fabricate full arch prosthesis just using a digital devices and confirmed satisfying result.

Animal Experiments of Heart Transplantation for Complicated Congenital Heart Disease in Neonate (신생아의 복잡심장기형에서 심장이식을 위한 동물실험)

  • 박영환;윤치순;정원석;김명옥;조범구
    • Journal of Chest Surgery
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    • v.32 no.6
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    • pp.504-509
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    • 1999
  • Background: Heart transplantation is considerated for a selected certain group of complicated congenital heart disease in neonates because corrective surgery is very difficult and has high mortality. Precise planning of transplantation is necessary to adequately fit the donor heart to the recipient. Material and Method: We have performed 4 neonatal pig heart transplantations to test the technical feasibility. Experiment 1: The transplantation was performed using the same technique as the adult heart transplantation. Experiment 2: The transplantation for hypoplastic left heart syndrome was simulated as we reconstructed the whole aortic arch with donor aorta. Experiment 3: The heart transplantation was done with radical pulmonary artery reconstruction. Experiment 4: The experiment was performed for a long term survival. Result: Preoperative planning was very important for adequate fitting. All animals could be weaned from cardiopulmonary bypass, however, two animals died due to bleeding at pulmonary artery and left atrium. Conclusion: We concluded that the neonatal heart transplantation can be applied in some complicated Further using animal model is mandatory.

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Fixed Prosthetic Restoration in an Edentulous Patient with NobelGuideTM System (양악 무치악 환자에서 NobelGuideTM 시스템을 이용한 고정성 임플란트 보철수복)

  • Shin, Hyoung-Joo;Kim, Dae-Gon;Cho, Lee-Ra;Park, Chan-Jin
    • Journal of Dental Rehabilitation and Applied Science
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    • v.25 no.3
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    • pp.243-253
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    • 2009
  • This report described a technique utilizing a computer-aided design (CAD) /computer-aided machining (CAM) - guided surgical implant placement and prefabricated fixed complete denture for an immediately loaded restoration. A patient with an edentulous maxilla and mandible received 6 implants in maxilla and 6 implants in the mandible using CAD/CAM surgical templates. Prefabricated provisional maxillary and mandibular implant supported fixed prostheses were connected immediately after implant installation. Provisional prostheses were evaluated for aesthetics, function during 6 months. Definitive prostheses were fabricated.

Complete mouth rehabilitation with fixed implant-supported prosthesis using temporary denture and dental CAD-CAM (완전 무치악 환자에서 임시 의치와 치과용 CAD-CAM을 활용한 전악 고정성 임플란트 회복 증례)

  • Jeon, Sol;Yoon, Hyung-In;Lee, Jae-Hyun;Yeo, In-Sung Luke;Han, Jung-Suk
    • The Journal of Korean Academy of Prosthodontics
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    • v.60 no.1
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    • pp.100-109
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    • 2022
  • Installation of dental implants at optimal angles and positions is critical in long-term stable implant-supported restorations. Surgery and prosthodontic procedures should be performed accurately as the treatment is planned. In this clinical case, Computer aided design and manufacturing technology was used not only to establish a precise surgical plan, but also to fabricate both provisional and definitive fixed prostheses. A surgical guide was designed to install the implants at proper positions for the definitive prostheses. The patient's esthetic information, which was necessary for the new provisional and definitive fixed prostheses, was obtained from the existing temporary dentures. Finally, the complete mouth fixed implant-supported rehabilitation using monolithic zirconia provided the patient with functionally and esthetically satisfactory prostheses.

The use of surgical guide stent for implant placement (임플란트 식립을 위한 수술 가이드의 사용)

  • Lee, Ji-Yeon;Yoon, Ji-Young;Oh, Namsik
    • The Journal of Korean Academy of Prosthodontics
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    • v.52 no.4
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    • pp.366-375
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    • 2014
  • Surgical guide not only provide diagnosis and treatment plan, but even location and direction of implantation. Surgical guide could be divided into non-limited design, partially limited design, and completely limited design. Partially limited design is easily manufactured and inexpensive but less accuracy, compared to completely limited design. From this approach, partially limited design may be particularly effective in patients who present with a single missing tooth or partially edentulous teeth. Completely limited design is anatomically accuracy, esthetical and functional, optimized treatment for prosthetic and biomechanical perspective, and also minimizes discomfort for post-treatment. The purpose of this study is to review previous studies of various surgical guides and applying in clinic.