• Journal of Chest Surgery
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• v.26 no.1
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• pp.44-46
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• 1993

There are several methods for managing pneumothorax through thoracoscope. Among them, electric cautery of bleb or bulla is very simple to do and can be done through the conventional thoracoscope. It is cosmetically excellent because it needs only incision. It is economically cheap comparing other methods because it does not need staplers or clips and other disposables. However, this method has been controversial for its success rate because of the ability of sealing off the air-leaking from the lung tissue. To evaluate the success rate, 29 cases of pneumothorax treated by electric cautery and instillation of oxytetracyline solution through the thoracoscope were analyzed. Among 29 patients, 18 were male and 11 female ranging 17 to 43 years old. The indications for thoracoscopy were recurrence in 20 cases and persistence in 9 cases. The underlying casuses of pneumothorax were bleb in 10 cases and bulla with bleb or not in 19 cases. Twenty one cases were successful [4%] and 8 cases were failed. The failed 8 cases were explored from 14 to 28 days after thoracoscopy.Six cases were explored through transaxillary minithoracotomy and 2 were done through limited posterolateral thoracotomy. The causes of failure were the necrotic lung tissue occured by excessive electric cautery in 6 cases and the necrotic lung tissue and residual bulla in two cases. In 10 bleb cases, 9 were successful [90.0%]. But in 19 cases of bulla, 12 were successful [63.2%]. In conclusion, the success rate of electric cautery through thoracoscope was 72. 4% and the causes of failure were lung necrosis and residual bulla. The success rate of the bleb cases was higher than that of the bulla cases.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.388-392
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• 1998

Hyperhidrosis is one of abnormalities in autonomic nervous system, it has been treated with dermatologic principles or thoracic sympathectomy via thoracotomy. But these techniques were rather ineffective or invasive. Recently, Video Assisted Thoracoscopic Surgery(VATS) is widely applided in thoracic surgical area, and palmar & axillary hyperhidrosis is not the exception. From August 1995 to February 1997, 52 patients with bilateral palmar hyperhidrosis underwent bilateral thoracic sympathectomy with VATS in the department of thoracic & cardiovascular surgery, Inje university, Pusan Paik Hospital. There were 27 men and 25 women and the mean age was 22 years. Mean operating time was 172 min and unilateral sympathectomy via minithoracotomy was applied in one patient due to severe pleural adhesion. Mean postoperative hospital stay was 2.6 days. During mean 12.5 months follow-up, there was no recurrence of sweating in the both hands. Thirty patients(57.7%) complained moderate degree of compensatory sweating, but the discomfort was decreased in severity. 83.8% of all patients were satisfied with the result of operation.

• Journal of Chest Surgery
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• v.34 no.4
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• pp.351-355
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• 2001

개흉술에 의한 수술적 폐쇄방법 및 경도관 동맥관 폐쇄술은 동맥관 개존중의 치료방법으로 발전되어 왔으나, 이러한 술식은 개흉술에 의한 합병증, 지속적인 단락 및 용혈의 가능성, 기구의 이동이나 색전증의 발생, 지속적인 단락시 세균성 심내막염 방지를 위한 지속적인 항생제 사용등의 단점이 있어 저자들은 흉강경을 이용한 수술을 시행하였다. 총 6례의 환자에서 흉강경을 이용한 동맥관 개존증 수술을 시행하였으며. 이중 대동맥 외막(adventitia) 박리중 지형이 잘 되지 않았던 1례에서는 소개흉술(minithoracotomy)로 전환하였다. 술 후 이시행한 이학적 검사상에서 모든 환아에 심잡음이 소실되었음을 확인할 수 있었으며, 흉부 방사선 검사상 점진적인 폐혈관음영의 감소를 관찰할 수 있었으며 수술중 동맥관 파열이나 불완전한 동맥관 폐쇄, 기흉, 애성(hoarseness) 등의 합병증은 발생되지 않았다. 환아들은 술후 평균 3.4일째 퇴원하였으며, 퇴원후 외래추적 관찰검사시 시행한 심초음파 검사상 동맥관의 재개통이나, 잔류단락은 관찰되지 않았다. 본원에서는 개흉술 및 경도관 동맥관 폐쇄술의 단점을 방지할수 있으며, 성공적인 동맥관 폐쇄, 작은 피부절개 반흔에 의한 미용적 효과, 짧은 재원기간등의 장점을 가진 흉강경을 이용항 동맥관 결찰술을 시해앟여 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.434-440
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• 2009

Background: Surgical closure of a patent ductus arteriosus (PDA) can be considered when conservative medical treatment is ineffective or contraindicated. Low weight and earlier gestational age neonates who are treated with conservative medical therapy generally showed a higher failure rate. The morbidity of surgical PDA closure in such extremely low birth weight (ELBW) neonates is also high. Here we present the early results of a new technique for approaching the PDA through a dorsal minithoracotomy. Material and Method: From March 2006 to November 2008, 24 premature neonates underwent surgical PDA closure. The procedures were performed in the newborn intensive care unit via a 2 cm long dorsal minithoracotomy with the baby in the prone position with the left hemithorax elevated 30$^{\circ}$. Bimanual cotton swab blunt dissection completed the extrapleural accesstothe PDA and then two clips were applied. Tube thoracostomy was avoided if there was no meaningful pleural laceration. Result: The infants mean gestational age was 26.5$\pm$2.1 weeks (range: 23 to 30 weeks) and the average age at operation was 11$\pm$11 days. The mean body weight at operation was 933$\pm$271 grams (range: 570 to 1,700 grams). Eight patients expired, but there was no procedure-related death. Postoperative echocardiography revealed two cases of residual shunt but none of these shunts were detected on the follow up echocardiogram that was performed on the post operative 5 and 59 days. Conclusion: We concluded that the technique described here is an effective procedure in view of the satisfactory operative exposure and the low rate of complications.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.366-370
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• 2005

Background: In general, cardiac surgery has been performed via median sternotomy. During the past decade, improvements in endoscopic equipment and operative techniques have resulted in development of minimally invasive cardiac operation using small incisions. With the advent of a voice controlled camera-holding robotic arm (AESOP 3000, Automated Endoscope System for Optimal Positioning), cardiac surgery entered the robotic age. Material and Method: Between April 2004 and December 2004, a total of seventy eight patients underwent robotic cardiac surgery, of whom sixty four patients underwent robot-assisted minimally invasive cardiac surgery via 5cm right lateral minithoracotomy using voice controlled robotic arm, femoral vessels cannulation, percutaneous internal jugular cannulation, transthoracic aortic cross clamp. Other fourteen patients underwent MIDCAB via internal mammary artery harvesting using AESOP. Result: Robotic cardiac surgery were mitral valve repair in 37 cases, mitral valve replacement in 10 cases, aortic valve replacement in 1 case, MIDCAB in 14 cases, ASD operation in 9 cases, and isolated Maze procedure in 1 case. In mitral operation, mean CPB time was $165.3\pm43.1$ minutes and mean ACC time was $110.4\pm48.2$ minutes. Median length of hospital stay was 6 days (range 3 to 30) in mitral operation, 4 days (range 2 to 7) in MIDCAB, and 4 days (range 2 to 6) in ASD operation. For complications, 3 patients were required by reoperation for bleeding. There was no hospital mortality. Conclusion: Our experience of robot cardiac surgery suggests that many cardiovascular surgeons will be able to perform minimally invasive cardiac operations through small incisions with robot-assisted video-direction. Well-designed studies and close long-term follow-up will be required to analyze the benefits of robot-assisted operation.

• Tuberculosis and Respiratory Diseases
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• v.45 no.6
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• pp.1199-1213
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• 1998

Background : The number of immunocompromised hosts has been increasing steadily and a new pulmonary infiltrate in these patients is a potentially lethal condition which needs rapid diagnosis and treatment. In this study we sought to examine the clinical manifestations, radiologic findings, and therapeutic outcomes of pulmonary mycoses presenting as a new pulmonary infiltrate in immunocompromised hosts. Method : All cases presenting as a new pulmonary infiltrate in immunocompromised hosts and confirmed to be pulmonary mycoses by pathologic examination or by positive culture from a sterile site between October of 1996 and April of 1998 were included in the study and their chart and radiologic findings were retrospectively reviewed. Results : In all, 14 cases of pulmonary mycoses from 13 patients(male : female ratio = 8 : 5, median age 47 yr) were found. Twelve cases were diagnosed as aspergillosis while two were diagnosed as mucormycosis. Major risk factors for fungal infections were chemotherapy for hematologic malignancy(10 cases) and organ transplant recipients(4 cases). Three cases were receiving empirical amphotericin B at the time of appearance of new lung infiltrates. Cases in the hematologic malignancy group had more prominent symptoms : fever(9/10), cough(6/10), sputum(5/10), dyspnea(4/10), chest pain(5/10). Patients in the organ transplant group had minimal symptoms(p<0.05). On simple chest films, all of the cases presented as single or multiple nodules(6/14) or consolidations(8/14). High resolution computed tomograph showed peri-lesional ground glass opacities(14/14), pleural effusions(5/14), and cavitary changes(7/14). Definitive diagnostic methods were as follows : 10 cases underwent minithoracotomy, 2 underwent video-assisted thoracoscopic surgery, 1 underwent percutaneous needle aspiration and 1 case was diagnosed by culture of abscess fluid. All cases received treatment with amphotericin B with 1 case each being treated with liposomal amphotericin B and itraconazole due to renal toxicity. Lung lesion improved in 12 of 14 patient but 4 patients died before completing therapy. Conclusion : When a new lung infiltrate develops presenting either as a nodule or consolidation in a neutropenic patient with hematologic malignancy or in a transplant recipient, you should always consider pulmonary mycoses as one of the differential diagnosis. By performing aggressive work up and early treatment, we may improve prognosis of these patients.