• Journal of Gastric Cancer
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• 제4권2호
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• pp.121-125
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• 2004

Purpose: Esophagojejunal anastomotic complications after a total gastrectomy include leakage, stenosis, bleeding, and abscess formation. Especially, the mortality rate for esophagojejunal anastomotic leakage is $80\%$. Although these complications hare been reduced by the usage of the EEA stapler, they are still serious and depend on various factors: the surgeon's experience, the stage of disease, the extent of surgical intervention, the method of operation, and the patient. Some local factors, such as vascularization of the graft, traction on the anastomosis suture line, and local infections, have been implicated as contributing to these complications. Materials and Methods: During the period $1995\∼2003$, of the 850 gastrectomies for gastric carcinomas, 171 were intra-abdominal total gastrectomies. All of these 171 operations were performed by one surgeon using a routine D2 lymph-node dissection and a 25-mm EEA stapler on an antecolic end-to-side esophagojejunostomy. In the 77 cases a seromuscular reinforced suture at the esophagojejunostomy site was performed, and in 94 cases, a whole layer reinforced suture with absorbible materials was used. We evaluated the incidence of complications according to age, sex, stage of patients, and combined resection. Also, we compared the incidences of complications for seromuscular and whole layer reinforced sutures. Results: The complications are major leaks ($2.9\%$), minor leaks ($3.5\%$), stenosis, bleeding ($1.8\%$), and abscess formation formation ($1.8\%$). In the five cases of major leaks, there were four mortalities with operative methods. The other patients with stenosis, bleeding, and abscess formation were treated conservatively with success. The incidences of complications were not related with age, sex, stages, and combined resection. The incidences of complications for the whole layer reinforced suture group ($2.9\%$) were less than those for the seromuscular reinforced group ($8.8\%$, P=0.04). Conclusion: The most serious complication of esophagojejunal anastomosis is major leakage with an $80\%$ mortality. The other complications are stenosis, bleeding, and abscess formation, for which no mortalities occurred during this study. Whole layer suture of the esophagojejunal anastomotic site is an important method for preventing leakage.

• Journal of Chest Surgery
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• 제18권3호
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• pp.461-465
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• 1985

Rupture of the aorta following blunt trauma of the thorax may occur more frequently than has generally been recognized. Actual complete transection of the aorta usually results in immediate death but varying degrees of lesser disruption permit increased chance of survival. Chronic traumatic aneurysms are so designated following a period of 3 months from the traumatic incident. The exact time required for the acute process and hematoma to convert into an aneurysm is unknown. Because a thoracic surgeon encounters so few of these aneurysms, it is difficult for him to arrive at sound dicta of management from his personal experience. It is not surprising that controversy exists concerning the therapeutic approach to the aneurysm which is asymptomatic and is discovered months or years after the causative injury. In the hope of improving the surgical treatment of patients with this condition, we reported one case with chronic traumatic aneurysm of the descending thoracic aorta.

• 대한기관식도과학회지
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• 제16권1호
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• pp.11-15
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• 2010

Minimally invasive surgery (MIS) has several advantages over conventional open surgery. Less pain, less morbidity, early recovery and better cosmetic outcomes are well-known benefits of MIS. However, indications of MIS are highly dependent on the experience of surgeon and the disease status, In the benign diseases with less surgical complexity, MIS can be performed relatively and safely. However. in advanced malignant diseases which require more complex surgical manipulation, the of patients and the principles of oncologic surgery should be considered before the selection of surgical methods, MIS would be performed more and more with aid or technologic advancement. However, long-term result with equivalent oncologic outcomes to open surgery is necessary to be one of standard surgical treatments in thoracic surgery.

• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.68-79
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• 2010

Lower abdominal tissue is regarded as an ideal donor site for the breast reconstruction because it provides large skin territory and huge amount of soft tissues enough to the breast size. However it is not easy for the surgeon to reconstruct the really natural breast, and needs the learning curve with long time experience. Author represent the various reconstruction procedures for the breast using lower abdominal tissue such as muscle sparing free TRAM, DIEP, and SIEA free flaps to reinsure like breast. Indications, and selection of reconstructive methods, surgical timing, selection of donor sites and recipient vessel of these flaps were reviewed. In addition, detailed procedures, surgical tips and secondary adjuvant procedures are described for more symmetry of reconstructed breast. The muscle sparing free TRAM, DIEP, and SIEA free flaps would be enough to provide supple, huge amount of well vascularized tissue for the breast, if these flaps were selected for the appropriate indication according to patient's general condition, obesity, the opposite breast and abdominal tissue condition. Lower abdominal tissue was able to provide versatile designs with sufficient adipose tissue without compromising the integrity of abdominal wall.

• Archives of Plastic Surgery
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• 제41권3호
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• pp.209-212
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• 2014

Microsurgery training in Singapore began in 1980 with the opening of the Experimental Surgical Unit. Since then, the unit has continued to grow and have held microsurgical training courses biannually. The road to becoming a full-fledged reconstructive surgeon requires the mastering of both microvascular as well as flap raising techniques and requires time, patience and good training facilities. In Singapore, over the past 2 decades, we have had the opportunity to develop good training facilities and to refine our surgical education programmes in reconstructive microsurgery. In this article, we share our experience with training in reconstructive microsurgery.

• Archives of Plastic Surgery
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• 제41권3호
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• pp.225-230
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• 2014

The increased application of the da Vinci robotic platform (Intuitive Surgical Inc.) for microsurgery has led to the development of new adjunctive surgical instrumentation. In microsurgery, the robotic platform can provide high definition $12{\times}-15{\times}$ digital magnification, broader range of motion, fine instrument handling with decreased tremor, reduced surgeon fatigue, and improved surgical productivity. This paper presents novel adjunctive tools that provide enhanced optical magnification, micro-Doppler sensing of vessels down to a 1-mm size, vein mapping capabilities, hydro-dissection, micro-ablation technology (with minimal thermal spread-$CO_2$ laser technology), and confocal microscopy to provide imaging at a cellular level. Microsurgical outcomes from the use of these tools in the management of patients with infertility and chronic groin and testicular pain are reviewed. All these instruments have been adapted for the robotic console and enhance the robot-assisted microsurgery experience. As the popularity of robot-assisted microsurgery grows, so will its breadth of instrumentation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권2호
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• pp.59-65
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• 2015

The extraction of third molars is a common task carried out at dental/surgery clinics. Postoperative pain is one of the two most common complications of this surgery, along with dry socket. Knowledge of the frequent risk factors of this complication is useful in determining high-risk patients, planning treatment, and preparing the patients mentally. Since the risk factors for postoperative pain have never been summarized before while the risk factors for dry socket have been highly debated, this report summarizes the literature regarding the common predictors of postextraction pain. Except for surgical difficulty and the surgeon's experience, the influences of other risk factors (age, gender and oral contraceptive use) were rather inconclusive. The case of a female gender or oral contraceptive effect might mainly be associated with estrogen levels (when it comes to dry socket), which can differ considerably from case to case. Improvement in and unification of statistical and diagnostic methods seem necessary. In addition, each risk factor was actually a combination of various independent variables, which should instead be targeted in more comprehensive studies.

• Journal of Chest Surgery
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• 제26권10호
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• pp.801-803
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• 1993

Surgical correction of patent ductus arteriosus is,under most circumstances,highly successful and carries a low mortality. But infected PDA is yet potentially dangerous due to its frequent recurrence and resistant organisms to antibiotics. And,in surgical correction,surgeon may face the possibility of tearing of ductus arteriosus arterial end due to friability and adhesion of its surrounding tissue.This report demonstrats another problem in treatment of infected patent ductus arteriosus.This thirteen years old female patient received susceptible combined antibiotics intravenously from the day of admission and remitted from 4th.week of therapy.This remission state continued for 12days without relapse.But the pulmonary artery ruptured in this remission period.In autopsy,bacteria was not found in ductal vegetation.Also,there was no pulmonary artery aneurysm,Our experience show that in infected PDA,pulmonary artery can rupture spontaneously during remission period without aneurysmal formation.

• Journal of Chest Surgery
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• 제27권5호
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• pp.399-401
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• 1994

We experienced one case of surgical treatment of A-V fistula between the right common iliac artery and the right common iliac vein after lumbar laminectomy. The average vascular surgeon does not have extensive experience with this disorder owing to its rarity. Arteriovenous fistula of the aorta and its major branches present an unparalleled challenge in patient care. Because of their central location, blood flow through these fistulas may be massive;the associated complications are usually dramatic, resulting in severe refractory congestive heart failure, massive venous hypertension, or extensive hemorrhage during an illfated surgical repair.For this reason, it behooves one to become well acquainted with the problem in order to avoid morbid complications and thus ensure optimal patient care.

• Journal of Chest Surgery
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• 제45권5호
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• pp.275-286
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• 2012

The saphenous vein has been the principal conduit for coronary bypass grafting from the beginning, circa 1970. This report briefly traces this history and concomitantly presents one surgeons experience and personal views on use of the vein graft. As such it is not exhaustive but meant to be practical with a modest number of references. The focus is that of providing guidance and perspective which may be at variance with that of others and recognizing that there may be many ways to accomplish the task at hand. Hopefully the surgeon in training/early career may find this instructive on the journey to surgical maturity.