• Journal of Korean Neurosurgical Society
• /
• 제46권4호
• /
• pp.312-316
• /
• 2009

Objective : The purpose of this study was to evaluate the efficacy of a transforaminal suprapedicular approach, semi-rigid flexible curved probe, and 3-dimensional reconstruction computed tomography (3D-CT) with discogram in the endoscopic treatment of non-contained lumbar disc herniations. Methods : The subjects were 153 patients with difficult, non-contained lumbar disc herniations undergoing endoscopic treatment. The types of herniation were as follows : extraforaminal, 17 patients; foraminal, 21 patients; high grade migration, 59 patients; and high canal compromise, 56 patients. To overcome the difficulties in endoscopic treatment, the anatomic structures were analyzed by 3D reconstruction CT and the high grade disc was extracted using a semi-rigid flexible curved probe and a transforaminal suprapedicular approach. Results : The mean follow-up was 18.3 months. The mean visual analogue scale (VAS) of the patients prior to surgery was 9.48, and the mean postoperative VAS was 1.63. According to Macnab's criteria, 145 patients had excellent and good results, and thus satisfactory results were obtained in 94.77% cases. Conclusion : In a posterolateral endoscopic lumbar discectomy, the difficult, non-contained disc is considered to be the most important factor impeding the success of surgery. By applying a semi-rigid flexible curved probe and using a transforaminal suprapedicular approach, good surgical results can be obtained, even in high grade, non-contained disc herniations.

• Current Optics and Photonics
• /
• 제5권5호
• /
• pp.532-537
• /
• 2021

We present a compact endoscopic probe in a needle form which has a fast beam-scanning capability for optical coherence tomography (OCT). In our study, a beam-scanning OCT imaging needle was fabricated with a 26G syringe needle (0.46 mm in outer diameter) and a thin OCT imaging probe based on the stepwise transitional core (STC) fiber. The imaging probe could freely rotate inside the needle for beam scans. Hence, OCT imaging could be performed without rotation or translation of the needle body. In our design, the structural integrity of the needle's steel tubing was preserved for mechanical robustness. Probing the optical signal was performed through the needle's own window formed at the end. For hand-held operation of our imaging needle, a light and compact scanner module (130 g and 45 × 53 × 60 mm³) was devised. Connected to the imaging needle, it could provide rotational actuation driven by a galvanometer. Because of its finite actuation range, our scanner module did not need a fiber rotary joint which might add undesirable complexity. The beam scan speed was 20 Hz and supported 20 frames per second at the maximum for endoscopic OCT imaging.

• Journal of Korean Neurosurgical Society
• /
• 제45권2호
• /
• pp.67-73
• /
• 2009

Objective : Although endoscopic procedures for lumbar disc diseases have improved greatly, the postoperative outcomes for high grade inferior migrated discs are not satisfactory. Because of anatomic limitations, a rigid endoscope cannot reach all lesions effectively. The purpose of this study was to determine the feasibility of endoscopic transforaminal suprapedicular approach to high grade inferior-migrated lumbar disc herniations. Methods : Between May 2006 and March 2008, a suprapedicular approach was performed in 53 patients with high grade inferior-migrated lumbar disc herniations using a rigid endoscope and a semi-rigid flexible curved probe. One-to-four hours after surgery, the presence of remnant discs was checked with MRI. The outcomes were evaluated with the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) one week after surgery. Results : The L2-3 level was involved in 2 patients and the L3-4 level was involved in 14 patients, while the L4-5 level was involved in 39 patients. There were single piece-type in 34 cases and a multiple piece-type in 19 cases. Satisfactory results were obtained in all cases. The mean preoperative VAS for leg pain was $9.32{\pm}0.43$ points (range, 7-10 points), whereas the mean ODI was $79.82{\pm}4.53$ points (range, 68-92 points). At the last follow-up examination, the mean postoperative VAS for leg pain was $1.78{\pm}0.71$ points and the mean postoperative ODI improved to $15.27{\pm}3.82$ points. Conclusion : A high grade inferior migrated lumbar disc is difficult to remove sufficiently by posterolateral endoscopic lumbar dscectomy using a rigid endoscope. However, a satisfactory result can be obtained by applying a transforaminal suprapedicular approach with a flexible semi-rigid curved probe.

• Journal of the Optical Society of Korea
• /
• 제15권3호
• /
• pp.300-304
• /
• 2011

Optical microscopes are widely used for medical imaging these days, but biopsy is a lengthy process that causes many problems during the ex-vivo imaging procedure. The endo-microscope has been studied to increase accessibility to the human body and to get in-vivo images to use for medical diagnosis. This research proposes a multi-modal confocal endo-microscope for bio-medical imaging. We introduce the design process for a small endoscopic probe and a coupling mechanism for the probe to make the multi-modal confocal endo-microscope. The endoscopic probe was designed to decrease chromatic and spherical aberrations, which deteriorate the images obtained with the conventional GRIN lens. Fluorescence and reflectance images of various samples were obtained with the proposed endo-microscope. We evaluated the performance of the proposed endo-microscope by analyzing the acquired images, and demonstrate the possibilities of in-vivo medical imaging for early diagnosis.

• Current Optics and Photonics
• /
• 제4권4호
• /
• pp.330-335
• /
• 2020

We have investigated optimization of the working distance (WD) for a highly miniaturized imaging probe for endoscopic optical coherence tomography (OCT). The WD is the axial distance from the distal end of the imaging probe to its beam focus, which is demanded for dimensional margins of protective structures, operational safety, or full utilization of the axial imaging range of OCT. With an objective lens smaller than a few hundred micrometers in diameter, a micro-optic imaging probe naturally exhibits a very short WD due to the down-scaled optical structure. For a maximized WD careful design is required with the optical aperture of the objective lens optimally filled by the incident beam. The diffraction-involved effect was taken into account in our analysis of the apertured beam. In this study, we developed a simple design formula on the maximum achievable WD based on our diffraction simulation. It was found that the maximum WD is proportional to the aperture size squared. In experiment, we designed and fabricated very compact OCT probes with long WDs. Our 165-㎛-thick fiber-optic probes provided WDs of 3 mm or longer w ith reasonable OCT imaging performance.

• Journal of the Optical Society of Korea
• /
• 제15권4호
• /
• pp.380-385
• /
• 2011

Common-path interferometers are widely used for endoscopic optical coherence tomography (OCT) because an arbitrary arm length can be chosen for the endoscopic imaging probe. However, the scheme suffers from the limited range of the sample position distance from the end of the imaging probe because the position between the reference reflector and the sample is limited by the optical path-length difference (OPD) to induce an interference signal. In this study, we developed a novel method for compensating the arbitrary sample position in common-path swept-source OCT by adding an extra Mach-Zehnder interferometer in the post-path of the interfered optical signal. Theoretical analysis and an experimental demonstration of imaging depth tuning for the flexible sample position of an endoscopic OCT image are discussed. After post-tuning of sample position distance, the positioning limitation between the reference reflector and the sample can be solved for various sample positions over a range of 26 mm for the cross-sectional images of a fish eye sample.

• 한국정보통신학회논문지
• /
• 제21권4호
• /
• pp.836-845
• /
• 2017

내시경기술의 발달로 인하여 내시경을 이용한 진단 및 시술이 활발하게 이루어지고 있다. 하지만 대장암의 증가와 정부의 암 조기검진사업의 영향으로 내시경진단 및 시술건수가 늘어나면서 천공 및 출혈 등 의료사고가 늘어나고 있다. 따라서 이러한 의료사고를 줄이기 위한 노력이 필요하다. 본 논문에서는 내시경 선단부의 방향정보와 선단부에 가해지는 힘을 실시간으로 제공하는 방법을 제시한다. 또한 내시경 시술시 선단부의 움직임이 매우 느린 것을 고려한 보간 상보필터를 제안하고 평가한다. 제안한 필터는 34.6%와 27.6% 성능개선 효과를 보였다. 제안한 방법을 내시경시스템에 적용 시 예상되는 사용자 인터페이스도 함께 제시한다. 이를 통해 제안방법이 내시경시스템에 적용 가능함을 보였다.

• Journal of Gastric Cancer
• /
• 제19권2호
• /
• pp.157-164
• /
• 2019

Purpose: Although standard radical gastrectomy is recommended after noncurative resection of endoscopic submucosal dissection (ESD) for early gastric cancer in most cases, residual tumor and lymph node metastasis have not been identified after surgery. The aim of this study is to evaluate the feasibility of sentinel node navigation surgery after noncurative ESD. Materials and Methods: This trial is an investigator-initiated, multicenter prospective phase II trial. Patients who underwent ESD for clinical stage T1N0M0 gastric cancer with noncurative resections were eligible. Qualified investigators who completed the prior phase III trial (SENORITA 1) are exclusively allowed to participate. In this study, 2 detection methods will be used: 1) intraoperative endoscopic submucosal injection of dual tracer, including radioisotope and indocyanine green (ICG) with sentinel basins detected using gamma-probe; 2) endoscopic injection of ICG, with sentinel basins detected using a fluorescence imaging system. Standard laparoscopic gastrectomy with lymphadenectomy will be performed. Sample size is calculated based on the inferior confidence interval of the detection rate of 95%, and the calculated accrual is 237 patients. The primary endpoint is detection rate, and the secondary endpoints are sensitivity and postoperative complications. Conclusions: This study is expected to clarify the feasibility of laparoscopic sentinel basin dissection after noncurative ESD. If the feasibility is demonstrated, a multicenter phase III trial will be initiated to compare laparoscopic sentinel node navigation surgery versus laparoscopic standard gastrectomy in early gastric cancer after endoscopic resection.

• Journal of the Optical Society of Korea
• /
• 제14권4호
• /
• pp.431-437
• /
• 2010

A stack of gradient-index (GRIN) rod lenses cannot be used for coherent anti-Stokes Raman scattering (CARS) microendoscopy for insertion to internal organs through a surgical keyhole with minimal invasiveness. That's because GRIN lens has large amount of inherent chromatic aberrations in spite of absolutely requiring a common focus for pump and Stokes beam with each frequency of ${\omega}_p$ and ${\omega}_S$. For this endoscopic purpose, we need to develop a long slender probe-type objective, namely probe-type microscope objective (PMO). In this paper, we introduce the structure, the working principle, and the design techniques of PMO which is composed of a probe-type lens module (PLM) and an adaptor lens module (ALM). PLM is first designed for a long slender type and ALM is successively designed by using several design parameters from PLM for eliminating optical discords between scanning unit and PLM. A combined module is optimized again to eliminate some coupling disparities between PLM and ALM for the best PMO. As a result, we can obtain a long slender PMO with perfectly diffraction-limited performance for pump beam of 817 nm and Stokes beam of 1064 nm.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제6권2호
• /
• pp.192-196
• /
• 2003

Angiodysplasia is the most common vascular abnormality of the gastrointestinal tract and probably the most frequent cause of recurrent lower intestinal bleeding in otherwise healthy elderly patients. Also, it is an important cause of hemorrhage in chronic renal failure observed in up to 19~32% of patients. Bleeding due to gastric angiodysplasia is treated by various endoscopic approaches, including argon and Nd : YAG laser photocoagulation, monopolar or bipolar electrocoagulation, heater probe, injection sclerotherapy, band ligation or hemoclipping. A 15-year-old boy, who had undergone hemodialysis for chronic renal failure for about 10 years, was admitted due to melena and progressive anemia. A gastroduodenoscopy revealed a cherry red and fern-like lesion with oozing on the posterior wall at junction of gastric body and fundus. Endoscopic hemoclipping therapy was performed. However, melena recurred four days later. Argon plasma coagulation and hemoclipping therapy were performed again. Since then, no recurrence of bleeding has been observed.