• Journal of Chest Surgery
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• v.57 no.4
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• pp.329-338
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• 2024

Background: Video-assisted thoracoscopic surgery (VATS) is recognized as a safe and effective treatment modality for early-stage lung cancer and anterior mediastinal masses. Recently, novel articulating instruments have been developed and introduced to endoscopic surgery. Here, we share our early experiences with VATS major pulmonary resection and thymectomy performed using ArtiSential articulating instruments. Methods: At the Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 500 patients underwent VATS pulmonary resection between July 2020 and April 2023, while 43 patients underwent VATS thymectomy between January 2020 and April 2023. After exclusion, 224 patients were enrolled for VATS major pulmonary resection, and 38 were enrolled for VATS thymectomy. ArtiSential forceps were utilized in 35 of the 224 patients undergoing pulmonary resection and in 12 of the 38 individuals undergoing thymectomy. Early clinical outcomes were retrospectively analyzed. Results: No significant differences were observed in sex, age, surgical approach, operation time, histological diagnosis, or additional procedures between the patients who underwent surgery using novel articulating instruments and the group treated with conventional endoscopic instruments for both VATS major pulmonary resection and thymectomy. However, the use of the novel articulating endoscopic forceps was associated with a significantly larger number of dissected lymph nodes (p=0.028) and lower estimated blood loss (p=0.009) in VATS major pulmonary resection. Conclusion: Major pulmonary resection and thymectomy via VATS using ArtiSential forceps were found to be safe and effective, with early clinical outcomes comparable to established methods. Further research into long-term clinical outcomes and cost-effectiveness is warranted.

• Journal of Chest Surgery
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• v.44 no.2
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• pp.165-168
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• 2011

Background: The prognosis of melanoma metastasized to other organs is very poor. There have been many studies on metastatic melanoma in Western society, but there have been few studies done in Korea because of the small number of cases. Materials and Methods: A retrospective review of 7 patients who underwent complete resection of pulmonary metastases from melanoma from January 2005 to December 2009 was performed. When the primary lesion was controlled or simultaneously controllable and no other metastatic lesion was found, pulmonary resections were performed. We analyzed the clinical prognoses after the initial melanoma diagnosis. Results: Of the seven patients, one was male and six were female. The mean age was 58.2 years (range 45~71). Six patients had a single pulmonary lesion and one patient had three lesions confined to the same lobe. The mean disease-free interval was 43.5 months (0~146 months). Before pulmonary resection, 4 patients had received systemic therapy. After pulmonary resection, 6 patients received systemic therapy. Complete resection was confirmed histologically. The metastasectomy was performed by wedge resection (6 patients) or lobectomy (1 patient). There were no mortalities or complications. After pulmonary resection, 1 patient had recurrent multiple lesions in the lung and 4 patients had metastases to other organs. The organs were the liver, brain, pleura, and lymph nodes. The mean observation time was 31.6 months and 3 patients died during observation. The mean survival was 27.7 months (14~60 months) and the 1-year and 3-year survival rates were 100% and 42%, respectively. Conclusion: When patients were selected carefully, the complete resection of pulmonary metastatic lesions was considered a major therapeutic tool.

• Korean Journal of Bronchoesophagology
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• v.17 no.2
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• pp.98-103
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• 2011

Purpose Pulmonary complications continue to be the major cause of morbidity and mortality after esophageal resection. The aim of this study was to compare and analyze retrospectively the factors which effect for postoperative pulmonary complications in patients who underwent curative resection for esophageal cancer. Material and Method A total of 118 patients were enrolled in the study from January 1994 to March 2009, and patients with previous neoadjuvant chemotherapy or radiotherapy were excluded. Of the total 118 patients, 27 patients developed pulmonary complications within 30 days of their operation. the factors which effect for postoperative pulmonary complications were compared and analyzed. Results There were 7 patients in-hospital deaths. 51 patients (43.2%) developed complications, and of them, the most common complication was pulmonary complication and occurred in 27 patients (22.9%). In univariate analysis, diabetes mellitus, cervical anastomosis through the retrosternal route, old age and poor lung function were risk factors contributing to postoperative pulmonary complications (p<0.05). In multivariate analysis, statistically significant factor was old age (65 years or older). Conclusion Clinical factor for the pulmonary complications after esophagectomy of esophageal cancer was significantly associated with diabetes mellitus, cervical anastomosis through the retrosternal route, old age (65 years or older) and poor lung function (FEV1<80%). Of these, old age was the most significant factor.

• Journal of Chest Surgery
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• v.18 no.3
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• pp.517-528
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• 1985

Pulmonary function studies today are generally accepted as an integral part of the evaluation of poor-risk patients who are to have pulmonary surgery. The effect of various pulmonary surgery on lung function was investigated in 54 patients in whom comprehensive lung function test were performed before and between 2 months and 14 months after operation at the Department of Thoracic Surgery, Seoul National University Hospital. According to the result of analysis, the effect of pulmonary resection on forced flow rate was keeping with the change of lung volume, and the preoperative level of ventilatory function plays a major role in determining postoperative loss of functioning lung. Although all measures of expiratory flow [FVC, FEV1, FEFO.2-1.2, MEF50, FEF25-75] have the same percentage of reproducibility, but FEV1 shows most sensitive, reliable linear correlation with the functioning pulmonary tissue loss than other parameters. The linear regression lines derived from the correlation between preoperative [X] and postoperative [Y] FEV1 on various surgical procedures were as follows: 1. Y = 0.57X 0.03. in pneumonectomy group of lung cancer[r=0.84]. 2. Y = 0.56X + 0.33. in lobectomy group of lung cancer[r=0.79]. 3. Y = 0.69X + 0.25. in lobectomy group of pulmonary infection[r=0.91].

• Journal of Chest Surgery
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• v.28 no.7
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• pp.689-692
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• 1995

Pulmonary aspergilloma is a rare disease, most commonly presenting as secondary invasion of preexisting cavitary disease. Tuberculosis and bronchieetasis were the commonest pre-existing diseases. Between 1990 and 1994, 11 patients[7 male and 4 female underwent thoracotomy for treatment of pulmonary aspergilloma. The mean age was 45.7 years. The most common indication for operation was hemoptysis. Lobectomy was the m&t frequent operation. Major complication occurred in a patient with bronchopleural fistula and treated with open drainage. There was no operative death. It is concluded that elective pulmonary resection is recommended for all patients with aspergilloma who do not constitute prohibitive operative risks.

• Journal of Chest Surgery
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• v.48 no.3
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• pp.193-198
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• 2015

Background: Patients on dialysis undergoing surgery belong to a high-risk group. Only a few studies have evaluated the outcome of major thoracic surgical procedures in dialysis patients. We evaluated the outcomes of pulmonary resection for non-small cell lung cancer (NSCLC) in patients on hemodialysis (HD). Methods: Between 2008 and 2013, seven patients on HD underwent pulmonary resection for NSCLC at our institution. We retrospectively reviewed their surgical outcomes and prognoses. Results: The median duration of HD before surgery was 55.0 months. Five patients underwent lobectomy and two patients underwent wedge resection. Postoperative morbidity occurred in three patients, including pulmonary edema combined with pneumonia, cerebral infarction, and delirium. There were no instances of in-hospital mortality, although one patient died of intracranial bleeding 15 days after discharge. During follow-up, three patients (one patient with pathologic stage IIB NSCLC and two patients with pathologic stage IIIA NSCLC) experienced recurrence and died as a result of the progression of the cancer, while the remaining three patients (with pathologic stage I NSCLC) are alive with no evidence of disease. Conclusion: Surgery for NSCLC in HD patients can be performed with acceptable perioperative morbidity. Good medium-term survival in patients with pathologic stage I NSCLC can also be expected. Pulmonary resection seems to be the proper treatment option for dialysis patients with stage I NSCLC.

• Journal of Chest Surgery
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• v.32 no.6
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• pp.549-555
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• 1999

Background: Patients who are considered for major pulmonary resection are generally evaluated by spirometry and clinical assessment to predict morbidity and mortality. Despite this, none has yet proved to be a convenient and reliable estimate of risk. Material and Method: A retrospective analysis was performed in 167 patients who were diagnosed for lung cancer, bronchiectasis, pulmonary tuberculosis, and other benign pulmonary disease, and who underwent major lung resections. The relationship of 25 preoperative or postoperative variables to 19 postoperative events were classified into categories as operative mortality, pulmonary or cardiovascular morbidity, and other morbidity was assessed. Logistic regression analysis and $\chi$2 analysis were used to identify the relationship of the operative risk factors to the grouped postoperative complications. Result: The best single predictor of complications was the percent predicted postoperative diffusing capacity (pulmonary morbidity, p<0.009; cardiovascular morbidity, p<0.003: overall morbidity, p<0.004). Conclusion: The diffusing capacity of the lung for carbon monoxide was an important predictor of postoperative complications than the spirometry, and it usually should be a part of the evaluation of patients being considered for pulmonary resection.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.381-384
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• 1986

Pulmonary aspergillosis is a relatively rare disease in Korea. Immune suppressive patients, resulting from misuse or long term therapy of antibiotics, steroid and anticancer chemotherapeutics tend to be vulnerable to pulmonary aspergillosis. This study is made to illustrate the clinical features, preoperative diagnosis and surgical role in the management is this diseases. In retrospective study of operative cases from May 1980 through July 1986, 10 cases were analysis. Hemoptysis and blood tinged sputum were the most common chief complaints. Major underlying pathology was cavitary lesion or bronchiectasis caused by pulmonary tuberculosis [5 cases]. 2 cases were disseminated form due to immune suppression. Anatomic location of lesion was in the upper lobe in half case. Systemic antifungal agent is helpful for invasive aspergillosis and Resection is the treatment of choice for localized fungus balls and symptomatic localized forms.

• Journal of Chest Surgery
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• v.22 no.3
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• pp.473-477
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• 1989

Pulmonary hamartoma has been considered as rare disease, which consists of lung tumor less than 1 %. Originally described by Albrecht in 1904, hamartoma is tumor like malformation-abnormal mixing of the normal components of organ-and is applied also to tumor found in many organs other than the lung. Lately, the major conclusions are that pulmonary hamartoma is neoplastic rather than developmental error in origin. Because pulmonary hamartoma frequently mimics lung cancer, especially in cancer-risk age groups, its clinical significance is great. Recently, we experienced 1 cases of endobronchial hamartoma which located at the right main stem bronchus. The patient was a 54 year old male who was admitted due to symptoms of fever 4 chilliness and dyspnea. Radiologic studies such as chest x-ray, chest tomogram and chest C-T scan revealed that the nearly total haziness of the right lung was caused by endobronchial tumor. The mass was considered as a benign by bronchoscopic exam, so we removed it surgically by tracheobronchotomy without pulmonary resection. Postoperative chest x-ray revealed satisfactory reexpansion of previous collapsed right lung. The patient discharged uneventfully.

• Tuberculosis and Respiratory Diseases
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• v.41 no.1
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• pp.42-46
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• 1994

Pulmonary Aspergillomas usually arise from proliferation of Aspergillus in preexisting parenchymal cavities.202 college students (99 men, 103 women) aged 18 to 26 years. Fasting blood samples were. The most common symptom in this disorder is hemoptysis, which may be minimal in amount or it may be massive & life threatening. The optimum therapy for pulmonary aspergilloma is controversial. The major options available include surgical resection of the lesion, a number of medical therapies, or simple observation of the patient for a time. Surgery is the most effective treatment but it is limited to some patient because most patients have underlying pulmonary disease. Thus the various form of medical therapy was available with successful result. The authors present a case of percutaneous intracavitary amphoterician B injection for the treatment of pulmonary aspergilloma & its successful effect for the repetitive hemoptysis.