• Journal of Yeungnam Medical Science
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• 제41권1호
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• pp.48-52
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• 2024

While simultaneous bilateral partial nephrectomy with a conventional multiport robot has been consistently reported since the 2010s, the introduction of the DaVinci SP system (Intuitive Surgical, Sunnyvale, CA, USA) could provide a novel way to perform surgery on bilateral kidneys while innovatively reducing the number of incisions. In our first report worldwide, the patient with bilateral small renal mass (2.0 cm for the left and 1.5 cm for the right side) and preoperative normal renal function was placed in the lateral decubitus position on an inverted bed. After tilting the bed to be as horizontal as possible, a 4-cm incision was made in the lower part of the umbilicus for the floating trocar technique. The partial nephrectomy was performed reliably as with the conventional transperitoneal approach, and then the patient could be repositioned to the contralateral side for the same procedure, maintaining all trocars. Total operation time (skin to skin), total console time, and the left- and right-side warm ischemic times were 260, 164, 27, and 23 minutes, respectively, without applying the early declamping technique. The estimated blood loss was 200 mL. The serum creatinine right after the operation, on the first day, 3 days, and 90 days after surgery were 0.92, 0.77, 0.79, and 0.81 mg/dL, respectively. For 90 days after the procedure, no complications or radiologic recurrence were observed. Further clinical studies will reveal the advantages of using the DaVinci SP device for this procedure over traditional multiport surgery, maximizing the benefit of a single port-based approach.

• Journal of Chest Surgery
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• 제54권4호
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• pp.294-301
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• 2021

Recent case series and meta-analyses have suggested that robot-assisted minimally invasive esophagectomy (RAMIE) could be a useful alternative to video-assisted thoracic surgery esophagectomy. The advantages of RAMIE are a 3-dimensional view, 7 degrees of freedom, and tremor filtering, which enable more meticulous lymph node dissection with a lower incidence of complications. However, in radical esophagectomy, understanding the concepts of the fascia and compartment is crucial for successful and reliable dissection. The first RAMIE in Korea was performed by our team in July 2006, and since then, we have developed related techniques to achieve better short- and long-term outcomes. The key step in RAMIE for esophageal squamous cell carcinoma is dissection of the upper mediastinum due to the difficulty of lymph node dissection and the high incidence of nodal metastasis in the area. Herein, we describe the technique of fascial plane dissection with esophageal suspension during RAMIE.

• Journal of Chest Surgery
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• 제45권6호
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• pp.396-400
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• 2012

Background: Surgery has been the classical treatment of pectus carinatum (PC), though compressive orthotic braces have shown successful results in recent years. We propose a non-operative approach using a lightweight, patient-controlled dynamic chest-bracing device. Materials and Methods: Eighteen patients with PC were treated between July 2008 and June 2009. The treatment involved fitting of the brace, which was worn for at least 20 hours per day for 6 months. Their degree of satisfaction (1, no correction; 4, remarkable correction) was measured at 12 months after the initiation of the treatment. Results: Thirteen (72.2%) patients completed the treatment (mean time, $4.9{\pm}1.4$ months). In patients who completed the treatment, the mean overall satisfaction score was $3.73{\pm}0.39$. The mean satisfaction score was 4, and there was no recurrence of pectus carinatum in patients who underwent the treatment for at least 6 months. Minimal recurrence of pectus carinatum after removal of the compressive brace occurred in 5 (38.5%) patients who stopped wearing the compressive brace at 4 months. Conclusion: Compressive bracing results in a significant improvement in PC appearance in patients with an immature skeleton. However, patient compliance and diligent follow-up appear to be paramount for the success of this method of treatment. We currently offer this approach as a first-line treatment for PC.

• 대한두개안면성형외과학회지
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• 제23권6호
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• pp.256-261
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• 2022

Background: Treating panfacial fractures (PFFs) can be extremely difficult even for experienced surgeons. Although several authors have attempted to systemize the surgical approach, performing surgery by applying a unidirectional sequence is much more difficult in practice. The purpose of this study was to review the literature on PFF surgery sequence and to understand how different surgical specialists-plastic reconstructive surgery (PRS) and oral maxillofacial surgery (OMS)-chose sequence and review PFFs fixation sequence in clinical cases. Methods: The PubMed and Google Scholar databases were scoured for publications published up until May 2020. Data extracted from the studies using standard templates included fracture part, fixation sequence, originating specialist, and the countries. Bibliographic details like author and year of publication were also extracted. Also, we reviewed the data for PFFs patients in the Trauma Registry System of Dankook University Hospital from 2011 to 2021. Results: In total, 240 articles were identified. This study comprised 22 studies after screening and full-text analysis. Sixteen studies (12 OMS specialists and 4 PRS specialists) used a "bottom-top" approach, whereas three studies (1 OMS specialist and 2 PRS specialists) used a "top-bottom" method. However, three studies (only OMS specialists) reported on both sequences. In our hospital, there were a total of 124 patients with PFF who were treated during 2011 to 2021; 64 (51.6%) were in upper-middle parts, 52 (41.9%) were in mid-lower parts, and eight (6.5%) were in three parts. Conclusion: Bottom-top sequencing was mainly used in OMS specialists, and top-bottom sequencing was used at a similar rate by two specialists in literature review. In our experience, however, it was hard to consistently implement unidirectional sequence suggested by a literature review. We realigned the reliable and stable buttresses first with tailoring individually for each patient, rather than proceeding in the unidirectional sequence like bottom-top or top-bottom.

• 대한치과교정학회지
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• 제45권2호
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• pp.59-65
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• 2015

Objective: To investigate skeletal and dental changes after application of a mandibular setback surgery-first orthodontic treatment approach in cases of skeletal Class III malocclusion. Methods: A retrospective study of 34 patients (23 men, 11 women; mean age, $26.2{\pm}6.6years$) with skeletal Class III deformities, who underwent surgery-first orthodontic treatment, was conducted. Skeletal landmarks in the maxilla and mandible at three time points, pre-treatment (T0), immediate-postoperative (T1), and post-treatment (T2), were analyzed using cone-beam computed tomography (CBCT)-generated half-cephalograms. Results: The significant T0 to T1 mandibular changes occurred $-9.24{\pm}3.97mm$ horizontally. From T1 to T2, the mandible tended to move forward $1.22{\pm}2.02mm$, while the condylar position (Cd to Po-perpendicular plane) shifted backward, and the coronoid process (Cp to FH plane) moved vertically. Between T1 and T2, the vertical dimension changed significantly (p < 0.05). Changes in the vertical dimension were significantly correlated to T1 to T2 changes in the Cd to Po-perpendicular plane (r = -0.671, p = 0.034), and in the Cp to FH plane (r = 0.733, p = 0.016), as well as to T0 to T1 changes in the Cp to Po-perpendicular plane (r = 0.758, p = 0.011). Conclusions: Greater alterations in the vertical dimension caused larger post-treatment (T2) stage skeletal changes. Studying the mandibular position in relation to the post-surgical vertical dimension emphasized the integral importance of vertical dimension control and proximal segment management to the success of surgery-first orthodontic treatment.

• 대한정형외과스포츠의학회지
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• 제6권2호
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• pp.77-82
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• 2007

투수의 견관절은 관절의 가동성과 안정성 사이에서 섬세한 균형이 요구된다. 이 균형은 쉽게 깨질 수 있어 손상으로 진행하게 된다. 성공적인 비수술적 치료의 제 1단계는 정확한 진단적 접근이다. 잘 설정되고 여러 단계에 걸친 방법으로 접근하는 재활을 시행함으로써 통증을 유발하는 염증 상태 개선 및 근육의 균형을 회복 관절의 유연성을 개선하고, 고유수용체 감각과 신경 근육 조절 능력을 개선하게 되어 효과적으로 운동 선수를 복귀시켜 줄 것이다. 이 글에서는 던지기 선수의 근골격계의 특이한 형태 변화와 특정 손상에 대한 다양한 형태의 재활 프로그램을 소개하고자 한다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제39권
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• pp.15.1-15.7
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• 2017

Background: This study constructed a partial-least-square path-modeling (PLS-PM) model and found the pathway by which the postsurgical vertical dimension (VD) affects the extent of the final mandibular setback on the B point at the posttreatment stage for the skeletal class III surgery-first approach (SFA). Methods: This study re-analyzed the data from the retrospective study by Lee et al. on 40 patients with skeletal class III bimaxillary SFA. Variables were obtained from cone beam computed tomography (CBCT)-generated cephalograms. Authors investigated all variables at each time point to build a PLS-PM model to verify the effect of the VD on the final setback of the mandible. Results: From PLS-PM, an increase in $VD_{10}$ was found to decrease the absolute value of the final setback amount of the mandible, which reflects the postsurgical physiological responses to both surgery and orthodontic treatment, which, in turn, can be interpreted as an increase in postoperative mandibular changes. Conclusions: To resolve the issue of collinear cephalometric data, the present study adopted PLS-PM to assess the orthodontic treatment. From PLS-PM, it was able to summarize the effect of increased postsurgery occlusal vertical dimension on the increased changeability of the B point position at the posttreatment stage.

• Journal of Chest Surgery
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• 제23권1호
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• pp.115-121
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• 1990

We have experienced twenty-eight patients of esophageal perforation at the department of thoracic and cardiovascular surgery, Seoul National University Hospital during the period from Jan. 1957 to Jun. 1989. The ratio between male and female patients was 17:11, and their age ranged from 2 years to 61 years old. [average: 30.4 years old] The cause of esophageal perforation were instrumental trauma in 9 cases, caustic perforation in 6 cases, spontaneous perforation in 6 cases, surgical trauma in 2 cases, and others in 5 cases. The most frequent location of perforation was in the lower third portion of the esophagus [13 case, 46 %]. Patients complained of chest pain [86 %], dyspnea [57 %], fever [57 %], subcutaneous emphysema [43 %], and others. The frequent complications of esophageal perforation were empyema [13 cases, 46 %] and mediastinitis [11 cases, 39 %]. The first treatment was supportive care in 3 cases, primary closure and reinforced procedures in 13 cases with 3 deaths, open drainage in 5 cases with 2 deaths, diversion in 4 cases with 2 deaths and closed thoracostomy drainage in 3 cases. After the first treatment, 6 patients received multi-staged operations for several months. Overall mortality was 25 %, and the most frequent cause of death was sepsis[57 %]. We thought that factors affecting the outcome of esophageal perforation are;[1] early diagnosis and adequacy in the first treatment, [2] intensive perioperative management including multi-stage surgical approach, [3] patient`s condition at the diagnosis

• Journal of Chest Surgery
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• 제27권7호
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• pp.603-609
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• 1994

Esophageal atresia is a rare congenital anomaly and it usually associated with tracheo-esophgeal fistula and other congenital anomalies. The first report of esophageal atresia with tracheo-esophageal fistula was done by Thomas Gibson in 1696. In 1941, Haight performed the first successful primary anastomosis for esophageal atresia. These accomplishments opened the gateway for clinical studies that have resulted in reinforcements and improvement in the care of infants born with this anomaly. From January 1986 to April 1994, 14 cases of esophgeal atresia with tracheo-esophgeal fistula were diagnosed in Kyung Hee Uinv. Hospital. There were 9 male and 5 female infants. 12 infants were Gross classification type C and 2 infants were type A. The average body weight was 2.7$\pm$0.4kg and Waterson Category A contained 4 infants, B contained 3 infants and C contained 7 infants. Among these infants, 9 infants were underwent anastomosis procedures. We performed retropleural approach in 6 infants, transpleural approach in 2 infants and 1 infant was performed colon interposition through substernal space.By the method of anastomosis, end-to-side anastomosis was performed in 5 infants, end-to-end anastomosis in 3 infants and esophagocologastrostomy in 1 infant.The former 8 infants were Gross classification type C and the latter was type A. Among the type C infants, 6 infants were anastomosed with one layer interrupted suture and 2 infants with 2 layer interrupted suture. Post- operative death was in 1 infant and 8 infants were discharged with good result and have been in good condition.

• Advances in pediatric surgery
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• 제19권2호
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• pp.90-97
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• 2013

Laparoscopic surgery has become popular in the past few decades, owing to less postoperative pain, fast recovery, and better cosmetic outcomes. The laparoscopic approach has been employed in pediatric surgery for the same reasons. After the first attempts of single incision laparoscopic appendectomy in pediatrics in 1998, single incision laparoscopic surgery (SILS) has recently been proven to be safe and feasible for the pediatric population. However, limitations have been reported for SILS, such as the wide learning curve, compared to standard laparoscopic surgery, and the restricted number of hospitals with surgical training programs including SILS. In this study, we intend to present our initial experiences with SILS in children, and to describe the technique, instruments used, and outcomes. This is a retrospective study of 71 pediatric patients who underwent SILS, at a tertiary medical center, between September, 2012 and August, 2013. Electronic medical records were reviewed for demographics, type of procedure, operation time, use of additional ports, conversion to open surgery, complications and hospital stay. Additional ports were inserted in 4 cases, for the purpose of traction. Postoperative complications were noted in 13 cases, which were mostly related to wound inflammation or formation of granulation tissue. According to our analyses, patients with complications had significantly longer use and more frequent use of pain killers. Notwithstanding the small sample size, many of the procedures performed in pediatric patients seem to be possible with SILS.