• 정보처리학회논문지B
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• 제10B권5호
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• pp.503-508
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• 2003

척추에 대한 외과수술은 신경조직을 손상하지 않아야 하기 때문에 수술 절차가 신중하게 계획되고 고도의 정밀을 요구한다. 척추성형술(verte-broplasty)은 골다공증으로 인한 척추의 골절을 치료하기 위해 제안된 비교적 새로운 외과적인 수술방법으로 최소침습적인 수술 기법으로 피부를 통하여 골절된 척추부위에 구멍을 내고 그곳에 PMMA(polymethylmethacrylate)라 불리는 골시멘트(bone cement)를 주입하여 치료하는 방법이다. 최근의 연구결과, 수술 후 즉각적인 고통의 경감을 가져오며, 골다공증으로 인한 골절부위에 강도가 강한 골시멘트를 주입하게 됨으로써 골다공증 척추체에 구조적인 안정성을 제공해 주는 것으로 알려져 있다. 수술 후 발생하는 합병증의 대부분은 과도한 골시멘트의 주입으로 인한 것으로 알려져 있으며, 따라서 척추성형술의 치료에 가장 중요한 요인은 주입한 골시멘트의 양을 조절하는 것이다. 이에 본 연구에서는 환자의 컴퓨터단층촬영(computer tomography)을 통하여 획득한 영상을 토대로 척추성형술 시술시 필요한 의료 영상 시스템을 설계 및 개발하고, 텍스처 분석을 통하여 개개인의 환자에게 필요한 골시멘트의 양을 계산하는 알고리즘을 개발하여 이를 실제 환자의 시술시에 적용해 보았다. 결과적으로 본 시스템은 척추성형술시에 최적의 골시멘트의 양을 예측할 수 있었으며, 정형외과의 다른 부위의 수술시에도 적용가능성을 확인할 수 있었다.

• 대한두개안면성형외과학회지
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• 제18권4호
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• pp.230-237
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• 2017

Background: The traditional approach for reduction of frontal sinus fractures is coronal incision. Inherent complications of the coronal approach include long scar, hair loss, and long operation time. We describe a simple approach for the reduction of frontal sinus anterior wall fractures using a suprabrow incision that is commonly used for brow lift. Methods: From March 2007 to October 2016, the authors identified patients with anterior wall frontal sinus fractures treated by open reduction through a suprabrow incision. Only cases with photographic/radiographic documentation and a minimum follow-up of 6 months were included. The incision line was designed to be at the upper margin of the eyebrow. Medical records and radiographic data were retrospectively reviewed. Surgical outcomes, cosmetic results, and complication were assessed. The patient scale of the patient and observer scar assessment scale was used to assess patient satisfaction for incisional scar at the 6-month follow-up. Results: Thirty-one patients underwent fracture reduction through a suprabrow approach during the study period, with a mean follow-up of 41 months. No patients showed any recurrent displacement, eyebrow asymmetry, or infection during follow-up. Thirteen patients reported their forehead paresthesia postoperatively, and 12 of them had preoperative symptom. One patient complained of incisional scar and underwent scar revision. All patients were satisfied with their eyebrow and forehead contour. Conclusion: The suprabrow approach allowed for an accurate reduction of the fractures in the anterior wall frontal sinus by providing direct visualization of the fracture. This transcutaneous approach can effectively restore forehead contour with acceptable postoperative complications and patient satisfaction.

• Journal of Gastric Cancer
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• 제20권4호
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• pp.431-441
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• 2020

Purpose: Various studies have indicated that reduced-port robotic gastrectomies are safe and feasible for treating patients with early gastric cancer. However, there have not been any comparative studies conducted that have evaluated patients with clinically advanced gastric cancer. Therefore, we aimed to compare the perioperative outcomes of D2 lymph node dissections during reduced-port robotic distal subtotal gastrectomies (RRDGs) and conventional 5-port laparoscopic distal subtotal gastrectomies (CLDGs). Materials and Methods: We retrospectively evaluated 118 patients with clinically advanced gastric cancer who underwent minimally invasive distal subtotal gastrectomies with D2 lymph node dissections between February 2016 and November 2019. To evaluate the patient data, we performed a 1:1 propensity score matching (PSM) according to age, sex, body mass index, American Society of Anesthesiologists physical status classification score, and clinical T status. The short-term surgical outcomes were also compared between the two groups. Results: The PSM identified 40 pairs of patients who underwent RRDG or CLDG. The RRDG group experienced a significantly longer operation time than the CLDG group (P<0.001), although the RRDG group had significantly less estimated blood loss (P=0.034). The number of retrieved extraperigastric lymph nodes in the RRDG group was significantly higher than that of the CLDG group (P=0.008). The rate of postoperative complications was not significantly different between the two groups (P=0.115). Conclusions: D2 lymph node dissections can be safely performed during RRDGs and the perioperative outcomes appear to be comparable to those of conventional laparoscopic surgeries. Further studies are needed to compare long-term survival outcomes.

• Journal of Chest Surgery
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• 제54권6호
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• pp.466-472
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• 2021

Background: Major intraoperative hemorrhage reportedly predicts unfavorable survival outcomes following surgical resection for esophageal carcinoma (EC). However, the factors predicting the amount of blood lost during thoracoscopic esophagectomy have yet to be sufficiently studied. We sought to identify risk factors for excessive blood loss during video-assisted thoracoscopic surgery (VATS) for EC. Methods: Using simple and multiple linear regression models, we performed retrospective analyses of the associations between clinicopathological/surgical factors and estimated hemorrhagic volume in 168 consecutive patients who underwent VATS-type esophagectomy for EC. Results: The median blood loss amount was 225 mL (interquartile range, 126-380 mL). Abdominal laparotomy (p<0.001), thoracic duct resection (p=0.014), and division of the azygos arch (p<0.001) were significantly related to high volumes of blood loss. Body mass index and operative duration, as continuous variables, were also correlated positively with blood loss volume in simple linear regression. The multiple linear regression analysis identified prolonged operative duration (p<0.001), open laparotomy approach (p=0.003), azygos arch division (p=0.005), and high body mass index (p=0.014) as independent predictors of higher hemorrhage amounts during VATS esophagectomy. Conclusion: As well as body mass index, operation-related factors such as operative duration, open laparotomy, and division of the azygos arch were independently predictive of estimated blood loss during VATS esophagectomy for EC. Laparoscopic abdominal procedures and azygos arch preservation might be minimally invasive options that would potentially reduce intraoperative hemorrhage, although oncological radicality remains an important consideration.

• Journal of Chest Surgery
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• 제56권2호
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• pp.90-98
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• 2023

Background: Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. Totally thoracoscopic ablation (TTA) is a surgical treatment showing a high success rate as a hybrid procedure with radiofrequency catheter ablation to control AF. This study compared the early complications of warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) in patients who underwent TTA. Methods: This single-center retrospective cohort study enrolled patients who underwent planned TTA for AF from February 2012 to October 2020. All patients received postoperative anticoagulation, either with warfarin or a NOAC (apixaban, rivaroxaban, dabigatran, or edoxaban). Propensity score matching was performed for both groups. Early complications were assessed at 12 weeks after TTA and were divided into efficacy and safety outcomes. Both efficacy and safety outcomes were compared in the propensity score-matched groups. Results: Early complications involving efficacy outcomes, such as stroke and transient ischemic attack, were seen in 5 patients in the warfarin group and none in the NOAC group. Although the 2 groups differed in the incidence of efficacy outcomes, it was not statistically significant. In safety outcomes, 11 patients in the warfarin group and 24 patients in the NOAC group had complications, but likewise, the between-group difference was not statistically significant. Conclusion: Among patients who underwent TTA, those who received NOACs had a lower incidence of thromboembolic complications than those who received warfarin; however, both groups showed a similar bleeding complication rate. Using a NOAC after TTA does not reduce efficacy and safety when compared to warfarin.

• Journal of Gastric Cancer
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• 제20권3호
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• pp.245-255
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• 2020

Purpose: Recently, non-exposure simple suturing endoscopic full-thickness resection (NESS-EFTR) was developed to prevent tumor exposure to the peritoneal cavity. This study aimed to evaluate the feasibility of NESS-EFTR with sentinel basin dissection for early gastric cancer (EGC). Materials and Methods: This was the prospective SENORITA 3 pilot. From July 2017 to January 2018, 20 patients with EGC smaller than 3 cm without an absolute indication for endoscopic submucosal dissection were enrolled. The sentinel basin was detected using Tc^99m-phytate and indocyanine green, and the NESS-EFTR procedure was performed when all sentinel basin nodes were tumor-free on frozen pathologic examination. We evaluated the complete resection and intraoperative perforation rates as well as the incidence of postoperative complications. Results: Among the 20 enrolled patients, one dropped out due to large tumor size, while another underwent conventional laparoscopic gastrectomy due to metastatic sentinel lymph nodes. All NESS-EFTR procedures were performed in 17 of the 18 other patients (94.4%) without conversion, and the complete resection rate was 83.3% (15/18). The intraoperative perforation rate was 27.8% (5/18), and endoscopic clipping or laparoscopic suturing or stapling was performed at the perforation site. There was one case of postoperative complications treated with endoscopic clipping; the others were discharged without any event. Conclusions: NESS-EFTR with sentinel basin dissection is a technically challenging procedure that obtains safe margins, prevents intraoperative perforation, and may be a treatment option for EGC after additional experience.

• Journal of Gastric Cancer
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• 제23권3호
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• pp.487-498
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• 2023

Purpose: Reduced port surgery (RPS) for gastric cancer has been frequently reported in distal gastrectomies but rarely in total gastrectomies. This study aimed to determine the feasibility of 3-port totally laparoscopic total gastrectomy (TLTG) with overlapping esophagojejunal (EJ) anastomosis. Materials and Methods: A total of 81 patients who underwent curative TLTG for gastric cancer (36 and 45 patients with 3-port and 5-port TLTG, respectively) were evaluated. All 3-port TLTG procedures were performed with the same method as 5-port TLTG, including EJ anastomosis with the intracorporeal overlap method using a linear stapler, except for the number of ports and assistants. Short-term outcomes, including the number of lymph nodes (LNs) harvested by station and postoperative complications, were analyzed retrospectively. Results: Clinical characteristics were not significantly different among the groups, except that the 3-port TLTG group was younger and had a lower rate of pulmonary comorbidity. There were no cases of open conversion or additional port placement. All operative details and the number of harvested LNs did not differ between the groups, but the rate of suprapancreatic LN harvest was higher in the 3-port TLTG group. No significant differences were observed in the overall complication rates between the 2 groups. Conclusions: Three-port TLTG with overlapping EJ anastomoses using a linear stapler is a feasible RPS procedure for total gastrectomy to treat gastric cancer.

• Journal of Chest Surgery
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• 제55권1호
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• pp.49-54
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• 2022

Background: We compared the safety and effectiveness of robotic anatomical resection and video-assisted thoracoscopic surgery (VATS). Methods: A retrospective analysis was conducted of the records of 4,283 patients, in whom an attempt was made to perform minimally invasive anatomical resection for lung cancer at Seoul National University Hospital from January 2011 to July 2020. Of these patients, 138 underwent robotic surgery and 4,145 underwent VATS. Perioperative outcomes were compared after propensity score matching including age, sex, height, weight, pulmonary function, smoking status, performance status, comorbidities, type of resection, combined bronchoplasty/angioplasty, tumor size, clinical T/N category, histology, and neoadjuvant treatment. Results: In total, 137 well-balanced pairs were obtained. There were no cases of 30-day mortality in the entire cohort. Conversion to thoracotomy was required more frequently in the VATS group (VATS 6.6% vs. robotic 0.7%, p=0.008). The complete resection rate (VATS 97.8% vs. robotic 98.5%, p=1.000) and postoperative complication rate (VATS 17.5% vs. robotic 19.0%, p=0.874) were not significantly different between the 2 groups. The robotic group showed a slightly shorter hospital stay (VATS 5.8±3.9 days vs. robotic 5.0±3.6 days, p=0.052). N2 nodal upstaging (cN0/pN2) was more common in the robotic group than the VATS group, but without statistical significance (VATS 4% vs. robotic 12%, p=0.077). Conclusion: Robotic anatomical resection in lung cancer showed comparable early outcomes when compared to VATS. In particular, robotic resection presented a lower conversion-to-thoracotomy rate. Furthermore, a robotic approach might improve lymph node harvesting in the N2 station.

• Journal of Chest Surgery
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• 제41권4호
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• pp.423-429
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• 2008

배경: 최근 수술 로봇을 이용한 심장수술에 대한 관심이 증가하고 있으나, 이에 대한 임상연구는 제한적이다. 본 연구는 2007년 8월부터 저자들에 의해 시행된 다빈치 수술 로봇을 이용한 심장수술의 조기 임상 경험을 보고하고, 로봇 심장수술 실현성 및 안정성을 살펴보고자 하였다. 대상 및 방법: 2007년 8월부터 12월까지 총 20명의 환자에게 다빈치 수술로봇을 이용한 심장수술을 시행하였다. 승모판막 질환(n=11), 삼첨판막 질환(n=1), 심방중격결손증(n=1)의 수술시에는 우측 대퇴 동정맥 및 우측 내경정맥을 이용한 말초 삽관 후 체외 순환을 시행하였고, 전방성 심정지액 투입 및 흘곽의 늑간을 통한 대동맥 겸자를 시행한 후 개심술을 시행하였다. 7명의 환자에서 최소 침습적 관상동맥 우회술(MIDCAB)을 시행하기 위하여 다빈치 수술로봇을 이용하여 좌측 혹은 양측 내흉동맥을 박리하였다. 결과: 환자의 평균 나이는 $50.1{\pm}15.1$세($26{\sim}78$)였으며, 11예의 승모판막 성형술시 3예의 Maze 수술 및 1예의 삼첨판막 성형술이 동반되었다. 평균 체외순환시간은 $208.0{\pm}61.3$분, 평균대동맥 차단시간은 $158.8{\pm}40.6$분이었다. 승모판막 성형술 후 2도를 초과하는 잔존하는 승모판막 역류는 없었으며 수술 후 재원 기간의 중간값은 4일이었다. 다빈치 수술로봇을 이용한 내흉동맥의 박리는 6명의 환자에서 좌측 내흉동맥을 박리하였고, 1명의 환자에서 양측 내흉동맥을 박리하였으며 평균 내흉동맥 박리 시간은 $43.2{\pm}12.0$분이었다. 박리된 내흉동맥은 양호한 혈류를 보였으며, 좌전 개흉술 후 직접시하에서 문합을 시행하였다. MIDCAB으로 시행한 문합의 개통률은 100% (18/18)였다. 결론: 다빈치 수술로봇을 이용한 심장수술은 승모판막 성형술, 삼첨판막 성형술, 심방중격 결손의 교정 및 관상동맥 우회술을 위한 내흉동맥의 박리 등에서 다양하게 적용되었으며, 비교적 안전하고 만족할만한 조기성적을 보였다. 본 연구를 계기로 국내에서도 다빈치 수술로봇을 이용한 심장수술의 임상적용 및 임상연구가 활발하게 진행될 것을 기대한다.

• Advances in pediatric surgery
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• 제20권1호
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• pp.1-6
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• 2014

Minimal invasive surgery (MIS) has rapidly gained acceptance for the management of a wide variety of pediatric diseases. A questionnaire was sent to all members of the Korean Association of Pediatric Surgeons. Thirty one members (25.4%) took part in the survey that included data for the year 2012: demographic details, opinion regarding minimal invasive surgery and robotic surgery, spectrum of minimally invasive operations, and quantity of procedures. 48.4% of the respondents had more than 10 years experience, 35.5% less than 10 years experience, and 16.1 % had no experience. The respondents of the recommend MIS and perform MIS for surgical procedures are as follow; inguinal hernia (61.3%), simple appendicitis (87.1%), complicated appendicitis (80.6%), reduction of intussusceptions (83.9%), pyloromyotomy (90.3%), fundoplication (96.8%), biopsy and corrective surgery of Hirschsprung's disease (93.5%/90.3%), imperforate anus (77.4%), congenital diaphragmatic hernia (80.6%), and esophageal atresia (74.2%). The MIS procedures with more than 70% were lung resection (100%), cholecystectomy (100%), appendectomy (96.2%), ovarian torsion (86.7%), fundoplication (86.8%), hiatal hernia repair (82.6%), and splenectomy (71.4%). The MIS procedures with less than 30% were congenial diaphragmatic hernia reapir (29.6%), esophageal atresia (26.2%), correction of malroatation (24.4%), inguinal hernia repair (11.4%), anorectal malformation (6.8%), Kasai operation (3.6%).