• Journal of Chest Surgery
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• v.27 no.3
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• pp.226-229
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• 1994

VATS is now used by many thoracic surgeons and in various anatomic locations such as lung parenchyme, pleura and mediastinum, etc. VATS of mediastinal masses has special characteristics compared to that of other diseases. Those are no positional changes of the mass during collapse of the lung and close proximity of the mass to major vascular structures, nerves and other vital organs. From 1992. July to 1993. August, 10 mediastinal masses were treated with video assisted thoracoscopy. There were five males and five females, ages ranged from 11 years to 65 years with average 37.7 17.7 years old. Of the 10 patients, 4 were bronchogenic cysts, 2 were teratoma, and the others were thymoma, neurilemmoma, pericardial cyst, and thymic cyst. Needle aspiration was done in large cysts and the working thoracotomy[or utility thoracotomy] was done in large solid masses for the purpose of easy dissection, easy handling and easy delivery of the mass. The average operation time were 155.6 6.8 minutes and the duration of air leakage were 1 2.2 days. The duration of the chest tube drainage were 3.3 2.6 days. The lengths of the postoperative hospitalization were 5.1 2.7 days which were shorter than those of 12 mediastinal masses treated with conventional thoracotomy during the same periods [p<0.05]. There was 1 patient converted to thoracotomy because of a bleeding at innominate vein. 3 postoperative complications were occured. Those were persistent air leakage for 7 days, diaphragmatic palsy and hoarseness which were recovered within 1 month. We conclude that mediastinal mass can be excised with video assisted thoracoscopy and the posthospitalization is reduced. But careful attention is required for avoiding injury to major vascular structures, nerves, and other vital organs.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.251-255
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• 1987

In this study, 186 cases of spontaneous pneumothorax experienced at the Dept. of thoracic and Cardiovascular surgery, chosun University Hospital during from Jan. 1978 to Mar. 1987 were analysed retrospectically. The results were as follows: 1. The sex ratio of the stadied patient was 2.5:! in male prominence and the incidence and the incidence was highest in the adolescence between 20-29 year of age. 2. The clinical symptoms were frequently Dyspnea (52.2%) and Chest pain (38.7%). The etiologic factors were as follows, Tuberculous origin in 55.9%, Unknown origin in 17.2%, Bullae in 11.8%. 3. In the method of treatment, closed thoracotomy was the most effective procedure in achieving the expansion of collapsed lung in 87.1%. Other methods were bed rest with high oxygen inhalation, thoracentesis and open thoracotomy. 4. The incidences of complication were developed in 12.4% and recurrent rates were seen in 9.7%.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1225-1231
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• 1997

Spontaneous pneumothorax is the sudden collapse of a lung usually caused by air leakage from a subvisceral pleural blob. Responses to closed thoracostomy,thoracentesls and simple observation are usually prompt and effective. But in some cases, these are unsucceful and open thoracotomy is indicated. A clinical evaluation was performed on 242 cases(236 patients) of open thoracotomy in spontaneous pneumoth rax who were admitted and treated at department of Thoracic and Cardiovascular Surgery. Masan Samsung General Hospital during the past 9 years from January 1988 to December 1996. The results were as follows 1. The sex ratio was male predominance(M:F=11.7:1) 2. The most common age group were 2nd, 3rd decades(2nd=29.3%, 3rd=30.2%). 3. The most common chief complaints were chest pain and dyspnea(chest pain=41.7%. dryspnea= 36.8). 4. The etiologic factors of spontaneous pneumothorax were primary spontaneous pneumothorax(86.4%), tuberculosis(9.1%), COPD(3.7%) and pleuritis(0.8%). 5. The site of spontaneous pneumothorax was 52.1% in right, 45.4% in left and 2.5% in both. 6. The common indications of open thoracotomy were recurrence(44.2%), persistent air leakage(31.8%) and inadequate expansion(15.7%). 7. The operative procedures were bullectomy or mechanical pleurodesis through posterolateral thoracotomy or median sternotomy. 8. The most frequent location of bulla or blob were apical segme t oi RUL(35.1%) and apicoposterior segment of LUL(41.3 %). 9. The number of bulla or blob were mainly 1 to 5(88%), and there were no significant differences among operation indications. 10. The size of bulla or bleb were mainly below 5cm(81%)and small bulla($\leq$1cm) were predominant in recurrence group but large bulla(>5cm)were predominant in persistent air leakage and inadequate expansion group. 11. The pleural adhesion was seen in 54.5%.(Recurrence group 64.1%,Persistent air leakage group 51.9%,Inadequate expansion group 47.4%).

• Journal of Chest Surgery
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• v.32 no.1
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• pp.43-48
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• 1999

Background: Although treatment of spontaneous pneumothorax by video-assisted thoracic surgery(VATS) has generally shown better clinical results than conventional thoracotomy, treatment of spontaneous pneumothorax by midaxillary thoracotomy(MAXT) has also shown good clinical results. The author studied to compare the clinical results of MAXT group I and VATS group II. Material and Method : Group I included 30 midaxillary thoracotomy among 83 operative cases of spontaneous pneumothorax from Jan. 1992 to Dec. 1993. Group II included 30 VATS among 101 operative cases of pneumothorax from Jan. 1994 to Aug. 1995. The author selected the 30 patients, age 18 to 25 years, with recurrent spontaneous pneumothorax in each group. The author analyzed the operative indication, gender, operating time, amounts of the used staplers, tube drainage, total amounts of analgesics used during postoperative 24hr, tube stay time, postoperative complications and mortality. Result: The follow-up periods of both procedures were from 6 to 43 months. The operating time from start of skin incision to end of skin closure was 84.79${\pm}$21.70(from 40 to 150) minutes in MAXT group I and 108.8${\pm}$42.02(from 58 to 120) minutes in VATS group II(P<0.001). The numbers of the used staples useo was 1.31${\pm}$0.6(from 0 to 3) in group I and 3.41${\pm}$2.37(from 0 to 11) in group II. The amounts of postoperative 24hour tube drainage were 220.76${\pm}$106.73(from 65 to 400) ml in group I and 260.63${\pm}$233.18(from 70 to 320) in group II(P>0.05). The amounts of postoperative 24 hourly used analgesics(Tarasyn ) was 1.38${\pm}$1.32(from 0 to 5) amples in group I and 0.72${\pm}$1.02(from 0 to 4) amples in group II (P<0.05). The postoperative tube stay is 5.45${\pm}$30.9 (from 3 to 7) days in group I and 4.75${\pm}$3.1(9 from 2 to 14) days in group II(P>0.05). The number of complications after operations was 2 cases of prolonged air leakage in group I, and in group II. (P is not significant). The number of recurrence after the operation was one in group I and also one in group II(P is not significant). In conclusion, there were no statistical differences in the postoperative 24 hour chest tube drainage, days of postoperative tube stay, postoperative complications and recurrence in the analysis between group I and group II. Conclusion: The author found that group II of VATS between 18 years and 25 years of age in recurrent spontaneous pneumothorax, statistically, requires longer operative time, more number of autosuture staples and less postoperative analgesic dosage than the midaxillary thoracotomy group I.

• Journal of Chest Surgery
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• v.2 no.1
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• pp.41-49
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• 1969

The authors made a clinical study of 80 cases of empyema who were diagnosed and treated at department of chest surgery, St. Mary`s Hospital, Chatholic Medical College, during the period of May.l964 through April.1969 and compared the empyema of infant and children with that of adults. 1. In age and sex ditribution, infant was 6 cases, childhood 22 cases and adult 52 cases. The ratio of male to female was 2.2:1. There`s a little difference in infant-childhood but prominence of males over females in adults was being 3. 3:1, in its ratio. 2. The cardinal symptoms were cough [61.3%], fever [60.0%] and dyspnea [52.8%]. The leukocytosis were observed in 83.7% of all cases, 96.2% of infant-childhood and 76.9% of adults. The hemoglobin level showed subnormal in 82.1% of infant-childhood and in 55.8% of adults. 3. Most frequent lesion to predisposing factor of empyema was pneumonia [43.7%],being prominent in infants children [64.3%] to that of adult 4. The Pathogenic organism by culture in 75 cases of empyema were staphylococuss [48%], streptococuss[9.3%], Gram[-] bacilli [9.3%], Klebsiella[2.7%], pneumococcus[4.0%], E. coli [5.4%] and no growth 21.3% in over all. Among the cases of empyema. staphlocal origin was 62.9% in infant-childfood and 39.6% adults. 5. Staphylococci were most susceptible to erythromycin [86. 1%], Kanamycin [75.0%], albamycin [61.7%] and neomycin [52.8%] but most resistant to penicillin, Chtoramphenicol and terramycin. 6. In the treatment of empyema, of 53 cases were closed thoracotomy drainage and the remainder of cases by open thoracotomy, decortication, thoracoplasty and pleuropneumonectomy. we could attain favourable results by only the closed thoracotomy in infant-childhood, 28 cases. 7. The mortality rate was 6.3% in over all; adult 3 cases, infant and children 2 cases. 3 cases of these, were due to staphylococcal infection.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.731-735
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• 1990

Simultaneous and non simultaneous bilateral spontaneous pneumothorax patients[273] were reviewed retrospectively from April 1986 to March 1990 in the Dept. of Thoracic and Cardiovascular Surgery, Kyung Hee University Medical College. The incidence of bilateral spontaneous pneumothorax was 13.6%[37] and sexual distribution was male dominant [Male:33, Female:4]. The patients were classified into three major groups according to therapeutic methods: Group I [7]; who were treated with simultaneous bilateral operation for unilateral recurred spontaneous pneumothorax through median sternotomy. Mean age was 20.7 years[17 \ulcorner28] and follow up duration was 7.7 months [3 weeks \ulcorner2 years]. Group II [23];who were treated with staged lateral thoractomy, unilateral thoracotomy and non simultaneous contralateral closed thoracostomy, or simultaneous or non simultaneous bilateral closed thoracostomy. Mean age was 28.6 years [17 \ulcorner56] and follow up duration was 9.8 months[one week \ulcorner3.5 years]. Group III[10] ;who were treated with simultaneous bilateral operation for simultaneous or non simultaneous bilateral spontaneous pneumothorax through median sternotomy. Mean age was 21.4 years[17 \ulcorner28] and follow up duration was 12.8 months[2 weeks \ulcorner2.7 years]. Among the patients managed through median sternotomy simultaneously [Group I and III], there were visible blebs or bullous changed lesions mainly in the apicoposterior segment bilaterally in 15 patients[88.2%] Postoperative complications were 3 cases in Group II [wound infection:2 cases, temporary left wrist drop: one case] but none in Group I and III. Spontaneous pneumothorax recurred in 2 cases, one in Group II and another in Group III but none in Group I. 12 cases of 94 patients[12.8%o] who were treated with unilateral thoracotomy needed contralateral thoracotomy mean 14.9 months[7.5 \ulcorner 25 months] later. Mean age was 20.9 years [17 \ulcorner28]. In conclusion, simultaneous bilateral operation through median sternotomy should be considered in managements of spontaneous pneumothorax, especially in late teens and early twenties except young women for cosmetic reasons.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.732-737
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• 2009

Background: Many video-assisted thoracic surgery (VATS) lobectomies are performed as a potential alternative to thoracotomy despite the controversy about the safety and the associated morbidity/mortality rates. Material and Method: Between November 2006 and August 2008, we performed 87 lobectomies (VATS 36, Thoracotomy 51) and we retrospectively reviewed the surgical treatment results. A VATS lobectomy was performed by a 4~5 cm thoracotomy without rib spreading and this included anatomic hilar dissection, individual vessel and bronchus stapling and lymph node dissection. Result: We studied 52 male and 35 female patients whose age ranged from 6 to 79 (average age: $59.8{\pm}15.0$ years). The cases were diagnosed with lung cancer (66) (SQC 24, ADC 38, others 4), pulmonary metastasis (2), carcinoid (2) and benign diseases (17). There was no intraoperative death. Postoperative complications were seen in 5 (15.6%) VATS and 33 (64.7%) thoracotomies, and perioperative death caused by adult respiratory distress syndrome occurred in 1 (2.8%) VATS and 3 (5.9%) thoracotomies. Three patients Underwent conversion to thoracotomy (8.3%). The mean time to chest tube removal was 6 days for VATS and 9.4 days for thoracotomy (p<0.001), and the mean length of the hospital stay was 8 days for VATS and 12.8 days for thoracotomy (p<0.001). Conclusion: VATS lobectomy can be performed safely with low morbidity/mortality rates. Furthermore, all the patients benefited from earlier postoperative rehabilitation and less pain and they were candidates for an earlier return to normal activities.

• Journal of Chest Surgery
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• v.28 no.5
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• pp.471-474
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• 1995

A total of 20 patients underwent bullectomy in the spontaneous pneumothorax between October 1993 and August 1994. The patients were divided into two groups: Control group; the patients who received with mid-axillary approach[n=10 , Experimental group; the patients who received with video-assisted thoracic surgery [n = 10 . The results were as follows; 1. The total sex distribution was male predominence [M :F=6:1 . Mean age of control group was 31.6$\pm$ 10.1 age and experimental group was 24.3$\pm$ 5.5 age. 2. The operative times were 117.0 $\pm$ 32.6min in control group and 102.5$\pm$ 38.4min in experimental group [not significant . 3. The indwelling period of postoperative chest tube and hospital stay were 4.5$\pm$ 2.6 days and 8.3 $\pm$ 1.8 days in control group, $1.5\pm$ 0.5 days and 3.1 $\pm$ 0.3 days in experimental group[p=0.0018, < 0.0001 . 4. In control group, injection times of pain-killer were 1.7$\pm$ 0.7 times/day at operative day and 0.4$\pm$ 0.6times/day at postoperative 1 day. In experimental group, there were 0.3$\pm$ 0.7times/day at operative day and 0.1 $\pm$ 0.3times/day at postoperative 1 day[p=O.O002 at operative day, not significant at postoperative 1 day .

• Journal of Chest Surgery
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• v.31 no.6
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• pp.604-609
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• 1998

Trauma to the thorax represents a significant portion of injuries seen in an inner-city emergency room. Although most of these patients may be sucessfully managed without thoracotomy, a certain percentage requires operative intervention either immediately or within several hours. 126 records of patients who had early thoracotomy for chest trauma from March 1986, to June 1997, in the Department of Thoracic and Cardiovascular Surgery in Masan Samsung General Hospital were reviewed. There were 96 males and 30 females whose ages ranged from 4 to 72 years, with a mean age of 32.8 years. The modes of injury were as follows : stab wounds, 55 cases(44%), blunt trauma, 70 cases(55%), and gunshot wound, 1 case(1%). Immediate operation was performed in 105 cases(84%) and delayed operation in 21 cases(16%). Indications that operation was necessary were hemorraging and shock in 66 cases(52%), cardiac tamponade in 27 cases(21%), and rupture of the diaphragm in 33 cases(27%). Most of these patients were sucessfully treated but 21 cases were resulted in death. The mortality rate was 16.6% and common causes of death were irreversible shock and hypoxia.

• Journal of Chest Surgery
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• v.11 no.1
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• pp.35-41
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• 1978

After the advent of the effective antimicrobial drugs, empyema of the pleural cavity came to be considered an infrequent disease. However, in recent years the problem of empyema is increasing, probably due to bacterial changes associated with the use and misuse of antimicrobials as well as alterations in the host associated with increased longevity and chronic disease. During the 10 years period from 1957, Sop. to 1977, Aug., we experienced 152 cases of empyema, of which 37 were scheduled on open thoracotomy drainge for chronic empyema. 1. The ratio of male to female was 3.6:1 with male predominance and 64% of total was above 40 years old in age distribution. 2. The cardinal symptoms were fever[70%], dyspnea[40.5%], and sputum[40.5%]. The leucocytosis were observed in 75.7% of all cases. The hemoglobin level showed subnormal in 21.6% of all cases. 3- The underlying pathology predisposing to empyema were postoperative empyema [35.1%] and tuberculosis[32.4%] in order. 4. The pathologic organisms by bacterial culture in 37 patients were Pseudomonas [24.3%], Staphylococccus [21.6%], Streptococcus [21.6%]., no growth [8. 1%] and the remainders. 5. The late results were as follow; a. Spontaneous closure was seen in 10 patients and all of them belongs to non-tuberculous group. Their mean duration was 14 months. b. Still opened are eight; 6 in tuberculous group, remainders in non-tuberculous group. c. Secondary closure was performed in 6 patients, of which 5 cases showed successful secondary closure but one failed. The mean duration from OTD to secondary closure was 46.3 days. d. Eleven patients were not followed. e. Two patients were expired; one was due to progressive cachexia and pulmonary insufficiency, the other due to gastrointestinal bleeding unrelated to empyema.