• Korean Journal of Computational Design and Engineering
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• v.17 no.5
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• pp.303-311
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• 2012

Laparoscopic surgery is a surgical procedure which uses long laparoscopic instruments through tiny holes in abdomen while watching images from a laparoscopic camera through umbilicus. Laparoscopic surgeries have many advantages rather than open surgeries, however it is hard to learn the surgical skills for laparoscopic surgery. Recently, some virtual simulation systems for laparoscopic surgery are developed to train novice surgeons or resident surgeons. In this study, we introduce the techniques that we developed for laparoscopic surgical training simulator for cholecystectomy (gallbladder removal), which is one of the most frequently performed by laparoscopic surgery. The techniques for cholecystectomy simulation include modeling of human organs (liver, gallbladder, bile ducts, etc.), real-time deformable body calculation, realistic 3D visualization of surgical scene, high-fidelity haptic rendering and haptic device technology, and so on. We propose each simulation technique for the laparoscopic cholecystectomy procedures such as identifying cystic duct and cystic artery to clamp and cut, dissecting connective tissues between the gallbladder and liver. In this paper, we describe the techniques and discuss about the results of the proposed cholecystectomy simulation for laparoscopic surgical training.

• Journal of Chest Surgery
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• v.22 no.2
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• pp.308-314
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• 1989

Pulmonary sequestration is a congenital malformation characterized by an area of embryonic lung tissue that derives its blood supply from an anomalous systemic artery. Two forms recognized: extralobar and intralobar. Extralobar form is a very rare congenital malformation, usually located in the lower chest, and may be found in newborn infants at the time a congenital diaphragmatic hernia is repaired. Large sequestrated segments may be cause acute respiratory distress in the neonate. The condition is asymptomatic in 15 per cent of patients. This report presents two cases of pulmonary sequestration which misdiagnosed a superior mediastinal tumor and a benign lung tumor. First case was 30-year-old male patient and chief complaints were dyspnea, dry cough and right chest pain. Chest X-ray showed a homogenous increased density of smooth margin at the right superior mediastinal area and suggested a benign mediastinal tumor. And so explothoracotomy was made without other special studies. Second case was 28-year-old male patient. One month ago, he had tracheostomy and right closed thoracostomy due to massive hemoptysis and spontaneous hemothorax. Chest X-ray showed a benign cystic lesion at RLL area. At the time of operation, in first case, a mass of adult fist size was placed medial to the right upper lobe and densely adhesive to trachea, SVC and esophagus. Blood supply of the mass was bronchial arteries of trachea and RUL bronchus and drained to SVC and azygos vein through anomalous systemic veins. There was no bronchial communication on Frozen biopsy. In 2nd case, large cystic lesion contained old blood hematoma was located in RLL and anomalous blood vessel from thoracic aorta was drained to posterior segment of RLL. In operation field, intralobar pulmonary sequestration was diagnosed, and RLL lobectomy was carried out.

• The Korean Journal of Gastroenterology
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• v.72 no.6
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• pp.313-317
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• 2018

During laparoscopic cholecystectomy, a surgical clip is used to control the cystic duct and cystic artery. In the past, metallic clips were usually used, but over recent years, interest in the use of Hem-o-lok clips has increased. Surgical clip migration into the common bile duct (CBD) after laparoscopic cholecystectomy has rarely been reported and the majority of reported cases involved metallic clips. In this report, we describe the case of a 53-year-old woman who presented with abdominal pain caused by migration of a Hem-o-lok clip into the CBD. The patient had undergone laparoscopic cholecystectomy 10 months previously. Abdominal CT revealed an indistinct, minute, radiation-impermeable object in the distal CBD. The object was successfully removed by sphincterotomy via ERCP using a stone basket and was identified as a Hem-o-lok clip.

• Radiation Oncology Journal
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• v.32 no.2
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• pp.63-69
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• 2014

Purpose: To find the applicability of adjuvant radiotherapy for extrahepatic bile duct cancer (EBDC), we analyzed the pattern of failure and evaluate prognostic factors of locoregional failure after curative resection without adjuvant treatment. Materials and Methods: In 97 patients with resected EBDC, the location of tumor was classified as proximal (n = 26) and distal (n = 71), using the junction of the cystic duct and common hepatic duct as the dividing point. Locoregional failure sites were categorized as follows: the hepatoduodenal ligament and tumor bed, the celiac artery and superior mesenteric artery, and other sites. Results: The median follow-up time was 29 months for surviving patients. Three-year locoregional progression-free survival, progression-free survival, and overall survival rates were 50%, 42%, and 52%, respectively. Regarding initial failures, 79% and 81% were locoregional failures in proximal and distal EBDC patients, respectively. The most common site was the hepatoduodenal ligament and tumor bed. In the multivariate analysis, perineural invasion was associated with poor locoregional progression-free survival (p = 0.023) and progression-free survival (p = 0.012); and elevated postoperative CA19-9 (${\geq}37U/mL$) did with poor locoregional progression-free survival (p = 0.002), progression-free survival (p < 0.001) and overall survival (p < 0.001). Conclusion: Both proximal and distal EBDC showed remarkable proportion of locoregional failure. Perineural invasion and elevated postoperative CA19-9 were risk factors of locoregional failure. In these patients with high risk of locoregional failure, adjuvant radiotherapy could be considered to improve locoregional control.

• Tuberculosis and Respiratory Diseases
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• v.70 no.1
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• pp.79-83
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• 2011

Pulmonary sequestration is a rare anomaly, in which a local area of a lung is supplied separately by an anomalous artery that arises from the aorta or one of its branches. Infection, mainly bacterial, is a major complication of sequestration. We report the case of a 17-year-old male patient, who presented with cough and fever. The contrast-enhanced chest computer tomomgraphy (CT) scans revealed an aberrant artery that originated from the descending thoracic aorta. He underwent a left-lower lobectomy. Macroscopically, the abnormal segment presented as multiple heterogenous cystic and solid lesions, and the cysts were filled with mucoid and pus-like material. Histology showed that the pulmonary parenchyma had been replaced by caseating epitheloid granulomas. The mycobacterial culture of his sputum was positive. On the basis of these results, the diagnosis of tuberculosis was established. The patient was treated with anti-tuberculous medication for 6 months, and 1 year later, his clinical status remained excellent.

• Parasites, Hosts and Diseases
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• v.55 no.4
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• pp.429-431
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• 2017

Hydatid cyst is usually located in the liver and lungs, rare cases showing localization in other organs or tissues. In the unusual location, echinococcosis is an excluding diagnosis that is established only after microscopic evaluation. Our first case occurred in a 67-year-old female previously diagnosed with pulmonary tuberculosis and hospitalized with persistent pain in the hip joint. The clinical diagnosis was tuberculosis of the joint, but the presence of the specific acellular membrane indicated a hydatid cyst of the synovial membrane, without bone involvement. Fewer than 25 cases of joint hydatidosis have been reported in literature to date. In the second case, the intramural hydatid cyst was incidentally discovered at autopsy, in the left heart ventricle of a 52-year-old male hospitalized for a fatal brain hemorrhage, as a result of rupture of an anterior communicating artery aneurysm. The conclusion of our paper is that echinococcosis should be taken into account for the differential diagnosis of cystic lesions, independently from their location.

• Journal of Korean Neurosurgical Society
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• v.61 no.1
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• pp.120-126
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• 2018

Intraparenchymal meningiomas without dural attachment are extremely rare, especially when they occur in basal ganglia region in child. An 8-year-old boy was admitted at our hospital, complaining of recurrent headache and vomiting for 3 months. Neurological examination showed impaired vision and mild paresis of the left extremities. Magnetic resonance imaging demonstrated a lesion located in the right basal ganglia region extending to superasellar cistern with solid, multiple cystic and necrotic components. Computed tomography revealed calcification within the mass. Due to the anterior cerebral artery involvement, a subtotal resection was achieved and postoperative radiotherapy was recommended. Histopathological examination indicated that the lesion was an atypical meningioma. The postoperative rehabilitation was uneventful. Mildly impaired vision and motor weakness of left extremities improved significantly and the patient returned to normal life after surgery. To our knowledge, intraparenchymal atypical meningioma in basal ganglia extending to superasellar cistern was never reported. The significance in differential diagnosis of lesions in basal ganglia should be emphasized.

• Journal of Chest Surgery
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• v.57 no.1
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• pp.92-95
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• 2024

Complete resection of an apicoposterior mediastinal mass is essential due to the mass effect, which exerts pressure on adjacent organs. Recently, the use of minimally invasive surgery has had many advantages. In this report, we describe a case in which a large apicoposterior mediastinal hypervascular mass was managed using a purse-string suture technique during robotic-assisted thoracoscopic surgery (RATS). The patient, a 77-year-old woman, was diagnosed with a 6.2-cm apicoposterior mediastinal hypervascular solid mass originating from the branches of the right subclavian artery. The patient underwent RATS for treatment. To obtain an adequate view of the apex of the thoracic cavity, a needle aspiration was performed, followed by the application of a purse-string suture technique. This was done to reduce the size of the tumor and to prevent catastrophic events such as seeding or spillage of the cystic mass. The mass was histopathologically diagnosed as a schwannoma. The patient was discharged on the first postoperative day without experiencing any complications.

• Korean Journal of Veterinary Research
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• v.32 no.4
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• pp.511-521
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• 1992

The distribution of the hepatic arteries within the liver in 30 Korean native cattle were observed. Vinylite solution was injected into the hepatic arteries of 10 livers for cast preparation. The angiography was prepared in 20 livers by injected 30% barium sulfate solution into the hepatic arteries and then radiographed on X-ray apparatus. The results were summarized as follow ; 1. The hepatic arteries were divided into the Ramus (R.) sinister, R. dexter and R. intermedius. The intrahepatic arteries were derived from the R. sinister and R. dexter. The R. intermedius divided into the Arteria(A.) gastrica dextra, A. gastroduodenalis and A. cystica. 2. The right branch (ramus dexter) of the hepatic artery supplies the right lobe and caudate process. It consisted of the A. dorsalis lobi dextri, A. ventralis lobi dextri and A. lobi caudati. They formed one common trunk with three arteries(6 cases, 20%), and two arteries formed common trunk with the A. ventralis lobi dextri and A. lobi caudati (16 cases, 52.8%), or with A. dorsalis lobi dextri and A. lobi caudati (5 cases, 16.5%). The three arteries arose from the A. hepatia independently(3 cases, 10%). 3. The left branch (ramus sinister), larger than the right and often double (6 cases, 20%), supplies the caudate, quadrate and left lobes, and often gives origin to the A. gastrica dextra. 4. The branches of hepatic artery in the left lobe were derived from A. dorsalis lobi sinistri, A. ventralis lobi sinistri and A. intermedius lobi sinistri. The A. intermedius lobi sinistri were absent in some cases (3 cases, 10%). They almostly originated a single branch and often two branches. 5. The A. cystica arose from the R. intermedius(27 cases, 90%) and A. hepaica(3 cases, 10%). 6. The Rami processus papillarum arose from dorsal border of the Pars transversa of the left branch(19 cases, 62.7%), the left branch and right branch (9 cases, 30%) or A. hepatica(2 cases, 6.6%). 7. The A. lobi quadrata arose from either the Pars transversa of left branch (12 cases, 40%) or A. hepatica(4 cases, 13.2%). It also arose from both Pars transversa of left branch and A. ventralis lobi sinistri (3 cases, 10%). 8. The anastomosis on the branches of A. hepatica was observed in intrahepatic and cystic arteries. The left and right branches ramified several secondary radiating branches within the liver. 9. The hepatic arteries formed a very short common trunk of the right branch ($18.75{\pm}11.89$ : 2.20~44.8mm) and a long Pars transversa of the left branch($72.85{\pm}20.04$ : 28.2~104.1mm). 10. The ramified angles at the A. dorsalis lobi dextri, A. ventralis lobi dextri, A. lobi sinistri, A. ventralis lobi sinistri, A. lobi quadrata, A. cystica and Rami processus papillarum were 50-80, 270-300, 340-20, 120-160, 160-290, 200-230, 250~290, 230~280 and 80~120 degrees, respectively.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.118-124
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• 1998

Minimally invasive coronary artery bypass grafting without using cardiopulmonary bypass (CPB) is a recently accepted modality of myocardial revascularization prcedures which is particularly suitable to the patients with lesions in the left anterior descending(LAD) and the right coronary arteries. Of the consecutive 35 patients of coronary artery bypass grafting performed at Sejong General Hospital from March to August 1996, six patients underwent minimally invasive coronary artery bypass grafting without CPB. All had stenotic lesions of the LAD more than 90%. Bypass grafting of the LAD was approached through midline sternotomy in one, through ministernotomy in two, and through limited left anterior thoracotomy in three patients, respectively. The internal mammary arteries were prepared without the use of thoracoscope. The mobilized mammary arteries were connected directly to the LAD in 5 patients, and the anastomosis required interposition of a segment of the radial artery in the remaining one. The diagonal branch was revascularized with the saphenous vein graft at the same time in one patient. No blood transfusion was necessary in 2 patients, and average blood required during surgery was 800ml in 4 patients. All patients were extubated from 4 to 14 hours(mean 9 hours) after operation. Early postoperative coronary angiography in 5 patients between 7 and 10 days after surgery has proved full patency of the grafts. With these limited clinical experiences, the clinical results demonstrated that minimally invasive coronary artery bypass grafting without CPB is an useful procedure especially in patients with isolated lesion in the proximal LAD.