• 대한의용생체공학회:의공학회지
• /
• 제28권3호
• /
• pp.332-337
• /
• 2007

In the early twenty-first century, minimally invasive surgery is the mainstay of various kinds of surgical fields. Surgeons gave percutaneously surgical treatment of the screw directly using a fluoroscopic view in the past. The latest date, they began to operate the fractured carpal bone surgery using Computerized Tomography (CT). Carpal bones composed of wrist joint consist of eight small bones which have hexahedron and sponge shape. Because of these shape, it is difficult to grasp the shape of carpal bones using only CT image data. Although several image segmentation studies have been conducted with carpal bone CT image data, more studies about carpal bone using CT data are still required. Especially, to apply the software implemented from the studies to clinical fIeld, the outcomes should be user friendly and very accurate. To satisfy those conditions, we propose modified multi-seed region growing segmentation method which uses simple threshold and the canny edge detector for finding edge information more accurately. This method is able to use very easily and gives us high accuracy and high speed for extracting the edge information of carpal bones. Especially, using multi-seed points, multi-bone objects of the carpal bone are extracted simultaneously.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제40권1호
• /
• pp.27-31
• /
• 2014

Various surgical techniques, such as endoscopic surgery and robotic surgery, are developed to optimize the esthetic outcome even in operations for malignancy. A modified face-lift or retroauricular approach are used to minimize postoperative scarring. Recently, robot-assisted surgery is being done in various fields and considered as favorable treatment method by many surgeons. However its high cost is a nonnegligible fraction for many patients. On the other hand, endoscopic surgery, which is cheaper than robotic surgery, is minimally invasive with contentable neck dissection. Although it is a difficult technique for a beginner surgeon due to its limited operation view, we suppose it as an alternative method for robotic surgery. Herein, we report two cases of endoscopic neck dissection via retroauricular incision with a discussion regarding the pros and cons of endoscopic neck dissection.

• Journal of Gastric Cancer
• /
• 제17권3호
• /
• pp.193-203
• /
• 2017

The implementation of national cancer screening has increased the detection rates of early gastric cancer (EGC) in Korea. Since the successful introduction of laparoscopic gastrectomy for gastric cancer in the early 1990s, this technique has demonstrated improved short-term outcomes without compromising long-term oncologic results. It is associated with reduced pain, shorter hospitalization, reduced morbidity rates, better cosmetic outcomes, and equivalent mortality rates as those for open surgery. Laparoscopic gastrectomy improves patients' quality of life (QOL) and provides favorable prognosis. Single-incision laparoscopic gastrectomy (SILG) is one extremely minimally invasive method, theoretically offering improved cosmetic results, less postoperative pain, and earlier recovery after surgery than conventional multiport laparoscopic gastrectomy. In this context, SILG is thought to be an optimal method to promote and maximize patients' QOL in the acute postoperative phase. However, the technical difficulties of this procedure have limited its use. Since the first report describing single-incision distal gastrectomy in 2011, only 16 studies to date have evaluated SILG. Most of these studies have focused on the technical feasibility and safety of SILG because its long-term outcomes have not been reported. This article reviews the advantages and limitations of SILG.

• 대한소아치과학회지
• /
• 제44권2호
• /
• pp.235-242
• /
• 2017

조대술 및 감압술은 악골내 치성기원 낭종에 대한 치료법으로서 여러 문헌을 통해 그 효과가 확립되어 왔다. 특히, 소아치과 영역에서 병소 크기가 크거나 발육 중인 치배 등 중요 구조물을 포함한 경우 보존적인 치료로서 우선적 대안이 될 수 있다. 조대술 후에는 낭종의 개방성 유지를 위해 맞춤 제작 아크릴 폐쇄장치(obturator) 또는 공간유지장치, 실리콘 관, 비강 캐눌라 등의 감압 스텐트(decompression stent)를 사용하는데, 이는 주변 연조직 자극 및 환아의 불편감, 낭종 크기 감소에 따른 탈락 가능성 등 임상적 문제점을 지니며 환아 협조도 저하의 원인이 되기도 한다. 본 증례들에서는 하악골 부위 영구 치배를 포함한 치성 낭종에 대하여 감압술시행시 16게이지 정맥 주사바늘을 활용한 금속관을 발치와를 통해 낭종 내부로 삽입하고 인접치에 레진으로 고정하는 최소 침습적 시술을 통해 환아의 양호한 협조하에 병소 제거 및 자발적 맹출을 유도하는 결과를 얻었기에 보고하는 바이다.

• Archives of Plastic Surgery
• /
• 제41권6호
• /
• pp.679-685
• /
• 2014

Background Frontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are still controversial. In this article, we suggest a simple reduction method using a subbrow incision as a treatment for isolated anterior sinus fractures. Methods Between March 2011 and March 2014, 13 patients with isolated frontal sinus fractures were treated by open reduction and internal fixation through a subbrow incision. The subbrow incision line was designed to be precisely at the lower margin of the brow in order to obtain an inconspicuous scar. A periosteal incision was made at 3 mm above the superior orbital rim. The fracture site of the frontal bone was reduced, and bone fixation was performed using an absorbable plate and screws. Results Contour deformities were completely restored in all patients, and all patients were satisfied with the results. Scars were barely visible in the long-term follow-up. No complications related to the procedure, such as infection, uncontrolled sinus bleeding, hematoma, paresthesia, mucocele, or posterior wall and brain injury were observed. Conclusions The subbrow approach allowed for an accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by providing a direct visualization of the fracture. Considering the surgical success of the reduction and the rigid fixation, patient satisfaction, and aesthetic problems, this transcutaneous approach through a subbrow incision is concluded to be superior to the other reduction techniques used in the case of an anterior table frontal sinus fracture.

• Journal of Korean Neurosurgical Society
• /
• 제30권8호
• /
• pp.992-997
• /
• 2001

Objectives : Essential hyperhidrosis is a common condition characterized by excessive body sweating. Excessive sweating beyond what is necessary to maintain normal body temperature need not be considered pathological unless it interferes with one's occupation and/or life-style. The existing non-operative therapeutic options seldom give sufficient relief or show a transient effect. In this regard, the thoracic sympathectomy may provide a definitive cure. In the past, surgical procedures were highly invasive and caused significant morbidity, but the minimally invasive thoracoscopic procedure provided detailed visualization of sympathetic ganglia and is associated with minimally postoperative morbidity. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential hyperhidrosis. In palmar hyperhidrosis, however, the level of sympathetic chain to be blocked has been somewhat obscure. It is assumed that the incidence of compensatory hyperhidrosis may closely related to the extent of thoracic sympathectomy. Material & Methods : To compare the results of posterior midline approach with endoscopic sympathectomy, and the results of T2 with T2, 3 sympathectomy or sympathicotomy, we retrospectively studied 62 patients treated for palmar hyperhidrosis between September 1993 and May 2000. We reviewed medical records and recently interviewed the patients by telephone calls. Results : The treatment effect of T2 sympathectomy is no different from T2, 3 sympathectomy. But, the incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than the T2, 3 sympathectomy group. Conclusion : Thoracoscopic sympathectomy is considered a simple, safe, and effective method for treating palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches. However, sympathicotomy seems to provide the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy.

• Journal of Chest Surgery
• /
• 제39권10호
• /
• pp.765-769
• /
• 2006

배경: 너스 시술은 누두흉 환자들의 전흉부 함몰을 교정하는 효과적인 수술방법으로 기존의 방법에 비하여 비침습적이다. 하지만 환자의 나이와 기형 형태에 따라 전흉부 함몰은 다양한 양상을 보이는 데, 이에 대하여 고전적인 너스 시술만을 고집할 때 기형 재발, 불충분 교정 등 다수의 합병증이 발생하였다. 따라서 저자들은 고전적인 너스 술식을 몇 가지 관점에서 보완하였다. 대상 및 방법: 1999년 11월부터 2004년 12월까지 135명의 환자와 216건의 수술경험을 후향적으로 분석하였다. 수술 전 컴퓨터 단층촬영, 수술 당시 환자의 연령, 수술방법, 재발을 포함한 합병증 여부를 분석하고, 이를 시술의 개선 전후로 나누어 비교하였다. 결과: 5년 2개월 동안 135명에서 너스 술식을 시행하였으며, 너스막대 제거술 64건, 재발 또는 합병증을 이유로 2번 이상의 너스 술식을 시행한 17건을 포함하여 너스 관련 216건의 수술을 시행하였다. 막대의 삽입위치를 절개부위에서 함몰부의 양족 경계부(늑연골의 최대 돌출부위)로 내측으로 이동시켜 흉곽 지지구조의 손상을 최소화하였고, 막대 성형 시 늑골과 접합하는 부분을 늑골모양에 맞게 성형하여 막대의 미끄러짐 현상을 줄였다. 그리고 막대와 늑골의 고정사를 바이크릴에서 강선으로 전환하고, 성인 환자의 경우, 수술 중 흉골을 견인하는 방법을 추가하였다. 1999년에서 2002년까지 17건에 달하던 재교정과 23건의 합병증이 개선 이후인 2003-2004년에는 재교정 0건, 합병증 3건으로 감소하였다. 결론: 이러한 결과로 미루어 보아, 본원에서 시행한 너스개선 술식은 효과적이었으며, 재발과 합병증을 획기적으로 줄일 수 있었다.

• Journal of Chest Surgery
• /
• 제34권6호
• /
• pp.472-476
• /
• 2001

배경: Nuss에 의한 누두흉의 최소 침습적 수술법은 연골 절제나 흉골절개가 없이 누두흉을 교정하는 새로운 수술법이다. 보고자는 Nuss술식의 조기 경험을 보고하는 바이다. 대상 및 방법: 1999년 12월에서 2001년 1월까지 20명의 누두흉 환자에서 Nuss술식을 시행하였다. 수술 대상은 남자 14 명, 여자 6 명으로, 1 세에서 33세까지 평균 10.1$\pm$7.7 세이며 대부분의 환자는(19명) 20세 이하였고, 33세된 성인 여자도 1명이 있었다. 결과: 가슴 함몰의 정도는 CT로 조사하였는데 CT지수는 평균 4.9$\pm$5.7 이었다. 평균 수술시간은 85.8$\pm$23.7 분이었다. 사용된 금속막대의 길이는 8 인치 에서 16인치 가지 평균 11.8$\pm$14.4 인치였다. 술후 조기 합병증은 3례의 환자에서 기흉이 있었고, 1례에서는 장마비, 전례에서 술후 통증조절을 위해 정맥진통제를 사용하였다. 1례의 성인 환자에서 술후 통증 조절을 목적으로 경막외 통증조절을 위한 도관을 삽입하였다. 그러나 전례에서 중대한 합병증은 발생치 않았다. 결론: 보고자가 누두흉 치료에 적용한 Nuss술식의 조기결과는 만족할만 하였지만 널리 이용되기에는 장기적인 관찰이 필요할 것으로 사료된다.

• Journal of Minimally Invasive Surgery
• /
• 제21권4호
• /
• pp.168-176
• /
• 2018

Purpose: Robotic-associated minimally invasive surgery is a novel method for overcoming some limitations of laparoscopic surgery. This study aimed to evaluate the outcomes (postoperative pain, cosmesis, surgeon's workload) of single-incision robotic cholecystectomy (SIRC) vs. single-incision laparoscopic cholecystectomy (SILC) vs. conventional three-port laparoscopic cholecystectomy (3PLC). Methods: 134 patients who underwent laparoscopic or robotic cholecystectomy at a single center during 2016~2017 were enrolled. Prospectively collected data included demographics, operative outcomes, questionnaire regarding pain and cosmesis, and NASA-Task Load Index (NASA-TLX) scores for surgeon's workload. Results: 55 patients underwent SIRC, 29 SILC, and 50 3PLC during the same period. 3PLC patient group was older than the others (SIRC vs. SILC vs. 3PLC: 48.1 vs. 42.2 vs. 54.1 years, p<0.001). Operative time was shortest with 3PLC (44.1 vs. 38.8 vs. 25.4 min, p<0.001). Estimated blood loss, postoperative complications, and postoperative stay were similar among the groups. Pain control was lowest in the 3PLC group (98.2% vs. 100% vs. 84.0%, p=0.004), however, at 2 weeks postoperatively there were no differences among the groups (p=0.374). Cosmesis scores were also worst after 3PLC (17.5 vs. 18.4 vs. 13.3, p<0.001). NASA-TLX score was highest in the SILC group (21.9 vs. 44.3 vs. 25.2, p<0.001). Conclusion: Although SIRC and SILC take longer than 3PLC, they produce superior cosmetic outcomes. Compared with SILC, SIRC is more ergonomic, lowering the surgeon's workload. Despite of higher cost, SIRC could be an alternative for treating gallbladder disease in selected patients.

• Journal of Korean Neurosurgical Society
• /
• 제67권1호
• /
• pp.60-72
• /
• 2024

Objective : Recently, robotic-assisted spine surgery (RASS) has been considered a minimally invasive and relatively accurate method. In total, 495 robotic-assisted pedicle screw fixation (RAPSF) procedures were attempted on 100 patients during a 14-month period. The current study aimed to analyze the accuracy, potential risk factors, and learning curve of RAPSF. Methods : This retrospective study evaluated the position of RAPSF using the Gertzbein and Robbins scale (GRS). The accuracy was analyzed using the ratio of the clinically acceptable group (GRS grades A and B), the dissatisfying group (GRS grades C, D, and E), and the Surgical Evaluation Assistant program. The RAPSF was divided into the no-breached group (GRS grade A) and breached group (GRS grades B, C, D, and E), and the potential risk factors of RAPSF were evaluated. The learning curve was analyzed by changes in robot-used time per screw and the occurrence tendency of breached and failed screws according to case accumulation. Results : The clinically acceptable group in RAPSF was 98.12%. In the analysis using the Surgical Evaluation Assistant program, the tip offset was 2.37±1.89 mm, the tail offset was 3.09±1.90 mm, and the angular offset was 3.72°±2.72°. In the analysis of potential risk factors, the difference in screw fixation level (p=0.009) and segmental distance between the tracker and the instrumented level (p=0.001) between the no-breached and breached group were statistically significant, but not for the other factors. The mean difference between the no-breach and breach groups was statistically significant in terms of pedicle width (p<0.001) and tail offset (p=0.042). In the learning curve analysis, the occurrence of breached and failed screws and the robot-used time per screw screws showed a significant decreasing trend. Conclusion : In the current study, RAPSF was highly accurate and the specific potential risk factors were not identified. However, pedicle width was presumed to be related to breached screw. Meanwhile, the robot-used time per screw and the incidence of breached and failed screws decreased with the learning curve.