• Journal of Korean Neurosurgical Society
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• 제61권5호
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• pp.653-659
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• 2018

Objective : Surgical obliteration of ruptured aneurysm of the proximal posterior inferior cerebellar artery (PICA) is challenging because of limited surgical accessibility. In recent years, coil embolization is the first-choice treatment for these lesions. However, coil embolization is not always easy in ruptured PICA aneurysm owing to the variable anatomical diversity of its shapes, its relationship to the parent artery, its low incidence, and accordingly, lesser neurointerventionist experience. Methods : The parent artery and microcatheter for easier navigation and the embolization technique for stable coiling were identified. Results : This study aimed to identify the more appropriate approach route, microcatheter, and strategies for an easier and safer, and more durable coil embolization in the treatment of lesions in the proximal PICA. Conclusion : Coil embolization for aneurysmal subarachnoid hemorrhage due to a ruptured proximal PICA remains a challenge, but with the appropriate coiling plan, it can be treated successfully.

• Journal of Chest Surgery
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• 제46권4호
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• pp.241-248
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• 2013

Esophageal cancer has one of the highest malignant potentials of any type of tumor. The 3-field lymph node dissection is the standard procedure in Japan for surgically curable esophageal cancer in the middle or upper thoracic esophagus. Minimally invasive esophagectomy is being increasingly performed in many countries, and several studies report its feasibility and curability; further, the magnifying effect of the thoracoscope is another distinct advantage. However, few studies have reported that minimally invasive esophagectomy is more beneficial than open esophagectomy. A recent meta-analysis revealed that minimally invasive esophagectomy reduces blood loss, respiratory complications, the total morbidity rate, and hospitalization duration. A randomized study reported that the pulmonary infection rate, pain score, intraoperative blood loss, hospitalization duration, and postoperative 6-week quality of life were significantly better with the minimally invasive procedure than with other procedures. In the future, sentinel lymph node mapping might play a significant role by obtaining individualized information to customize the surgical procedure for individual patients' specific needs.

• 제어로봇시스템학회논문지
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• 제20권3호
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• pp.345-355
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• 2014

Since the beginning of the 21st century, emergence of innovative technologies in robotic and telepresence surgery has revolutionized minimally access surgery and continually has advanced them till recent years. One of such surgeries is endoscopic surgery, in which endoscope and endoscopic instruments are inserted into the body through small incision or natural openings, surgical operations being carried out by a laparoscopic procedure. Due to a vast amount of developments in this technology, this review article describes only a technological state-of-the arts and trend of endoscopic robots, being further limited to the aspects of key components, their functional requirements and operational procedure in surgery. In particular, it first describes technological limitations in developments of key components and then focuses on the description of the performance required for their functions, which include position control, tracking, navigation, and manipulation of the flexible endoscope body and its end effector as well, and so on. In spite of these rapid developments in functional components, endoscopic surgical robots should be much smaller, less expensive, easier to operate, and should seamlessly integrate emerging technologies for their intelligent vision and dexterous hands not only from the points of the view of surgical, ergonomic but also from safety. We believe that in these respects a medical robotic technology related to endoscopic surgery continues to be revolutionized in the near future, sufficient enough to replace almost all kinds of current endoscopic surgery. This issue remains to be addressed elsewhere in some other review articles.

• Journal of Korean Neurosurgical Society
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• 제61권4호
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• pp.478-484
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• 2018

Objective : Cerebrovascular disease (CVD) was the third most common cause of death in South Korea in 2014. Evidence from abroad suggests that comprehensive stroke centers play an important role in improving the mortality rate of stroke. However, surgical treatment for CVD is currently slightly neglected by national policy, and there is still regional imbalance in this regard. For this reason, we conducted a survey on the necessity of, and the requirements for, establishing regional comprehensive cerebrovascular surgery centers (CCVSCs). Methods : This investigation was performed using the questionnaire survey method. The questionnaire was consisted with two sections. The first concerned the respondent's opinion regarding the current status of demand and the regional imbalance of cerebrovascular surgery in South Korea. The second section asked about the requirements for establishing regional CCVSCs. We sent the questionnaire to 100 board members of the Korean Society of Cerebrovascular Surgeons. Results : Most experts agreed that cerebrovascular surgery patients were concentrated in large hospitals in the capital area, and 83.6% of respondents agreed that it was necessary to alleviate the regional imbalance of cerebrovascular surgery. With regards to personnel, over 90% of respondents answered that at least two neuro-vascular surgeons and two neuro-interventionists are necessary to establish a CCVSC. Regarding facilities, almost all respondents stated that each CCVSC would require a neuro-intensive care unit and hybrid operating room. The survey asked the respondents about 13 specific neurovascular surgical procedures and whether they were necessary for a regional CCVSC. In the questions about the necessity of cerebrovascular surgical equipment, all seven pieces of equipment were considered essential by all respondents. A further five pieces of equipment were considered necessary on site: computed tomographic angiography, magnetic resonance angiography, conventional angiography, surgical microscope, and surgical navigation. Our results may provide a basis for future policy regarding treatment of cerebrovascular disease, including surgery. Conclusion : Raising the comprehensiveness of treatment at a regional level would lower the national disease burden. Policies should be drafted regarding comprehensive treatment including surgery for cerebrovascular disease, and related support plans should be implemented.

• Journal of Korean Neurosurgical Society
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• 제65권4호
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• pp.489-498
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• 2022

Spatial insight into intracranial pathology and structure is important for neurosurgeons to perform safe and successful surgeries. Three-dimensional (3D) printing technology in the medical field has made it possible to produce intuitive models that can help with spatial perception. Recent advances in 3D-printed disease models have removed barriers to entering the clinical field and medical market, such as precision and texture reality, speed of production, and cost. The 3D-printed disease model is now ready to be actively applied to daily clinical practice in neurosurgical planning, simulation, and training. In this review, the development of 3D-printed neurosurgical disease models and their application are summarized and discussed.

• 전자공학회논문지
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• 제53권1호
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• pp.118-125
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• 2016

본 논문에서는 얼굴 영역 수술용 네비게이션을 위한 스테레오 비전과 CT 영상을 이용하여 환자-영상 간 정합(Image to patient registration) 알고리즘의 성능을 평가한다. 환자 영상 간 정합은 스테레오 비전 영상의 특징점 추출과 이를 통한 3차원 좌표 계산, 3차원 좌표와 3차원 CT 영상과의 정합 과정을 거친다. 스테레오 비전 영상에서 3가지 얼굴 특징점 추출 방법과 3가지 정합 방법을 사용하여 생성될 수 있는 5가지 조합 중 정합 정확도가 가장 높은 방법을 평가한다. 또한 머리의 회전에 따라 환자 영상 간 정합의 정확도를 비교한다. 실험을 통해 머리의 회전 각도가 약 20도의 범위 내에서 Active Appearance Model과 Pseudo Inverse Matching을 사용한 정합의 정확도가 가장 높았으며, 각도가 20도 이상일 경우 Speeded Up Robust Features와 Iterative Closest Point를 사용하였을 때 정합 정확도가 높았다. 이 결과를 통해 회전각도가 20도 범위 내에서는 Active Appearance Model과 Pseudo Inverse Matching 방법을 사용하고, 20도 이상의 경우 Speeded Up Robust Features와 Iterative Closest Point를 이용하는 것이 정합의 오차를 줄일 수 있다.

• Restorative Dentistry and Endodontics
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• 제44권4호
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• pp.38.1-38.8
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• 2019

Navigation of the main root canal and dealing with a dens invaginatus (DI) is a challenging task in clinical practice. Recently, the guided endodontics technique has become an alternative method for accessing root canals, surgical cavities, and calcified root canals without causing iatrogenic damage to tissue. In this case report, the use of the guided endodontics technique for two maxillary lateral incisors with multiple DIs is described. A 16-year-old female patient was referred with the chief complaint of pain and discoloured upper front teeth. Based on clinical and radiographic findings, a diagnosis of pulp necrosis and chronic periapical abscess associated with double DI (Oehler's type II) was established for the upper left lateral maxillary incisor (tooth #22). Root canal treatment and the sealing of double DI with mineral trioxide aggregate was planned for tooth #22. For tooth #12 (Oehler's type II), preventive sealing of the DI was planned. Minimally invasive access to the double DI and the main root canal of tooth #22, and to the DI of tooth #12, was achieved using the guided endodontics technique. This technique can be a valuable tool because it reduces chair-time and, more importantly, the risk of iatrogenic damage to the tooth structure.

• Journal of Gastric Cancer
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• 제12권1호
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• pp.7-12
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• 2012

More than ten years have passed since the sentinel node (SN) concept for gastric cancer surgery was first discussed. Less invasive modified surgical approaches based on the SN concept have already been put into practice for malignant melanoma and breast cancer, however the SN concept is not yet placed in a standard position in gastric cancer surgery even after two multi-institutional prospective clinical trials, the Japan Clinical Oncology Group trial (JCOG0302) and the Japanese Society for Sentinel Node Navigation Surgery (SNNS) trial. What is the problem in the clinical application of the SN concept to gastric cancer surgery? There is no doubt that we need reliable indicator(s) to determine with certainty the absence of metastasis in the lymph nodes in order to avoid unnecessary lymphadenectomy. There are several matters of debate in performing the actual procedure, such as the type of tracer, the site of injection, how to detect and harvest, how to detect metastases of SNs, and learning period. These issues have to be addressed further to establish the most suitable procedure. Novel technologies such as indocyanine green (ICG) fluorescence imaging and one-step nucleic acid amplification (OSNA) may overcome the current difficulties. Once we know what the problems are and how to tackle them, we can pursue the goal.

• Journal of Korean Neurosurgical Society
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• 제60권3호
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• pp.380-384
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• 2017

Glioblastoma multiforme (GBM) is located most frequently in the cerebral hemispheres. Glioblastoma presenting as an extraaxial mass of cerebellopontine angle (CPA) is very rare in adults. We report a rare case of GBM arising in the CPA. The patient was a 71-year-old female, who complained of progressive gait disturbance and poor memory. Initial magnetic resonance imaging (MRI) revealed a $1.4{\times}1.3cm$ mass in the left CPA, with broad base to the petrous bone, showing homogenous enhancement. Follow-up MRI showed a rapid increase in size of mass ($2.7{\times}2.2cm$) with a necrotic portion. A stereotactic biopsy was done under the guidance of navigation system, and the histopathologic diagnosis was GBM, World Heath Organization grade IV. Further surgical resection was not performed considering her general condition, and the patient underwent concurrent chemotherapy with radiation therapy. Although rare, the possibility of glioblastoma should be included in the differential diagnosis of atypical CPA tumor.

• Journal of International Society for Simulation Surgery
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• 제2권1호
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• pp.17-25
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• 2015

Purpose In this paper, we propose a robust 3D vessel tracking algorithm by utilizing an active contour model and unscented Kalman filter which are the two representative algorithms on segmentation and tracking. Materials and Methods The proposed algorithm firstly accepts user input to produce an initial estimate of vessel boundary segmentation. On each Computed Tomography Angiography (CTA) slice, the active contour is applied to segment the vessel boundary. After that, the estimation process of the unscented Kalman filter is applied to track the vessel boundary of the current slice to estimate the inter-slice vessel position translation and shape deformation. Finally both active contour and unscented Kalman filter are inter-operated for vessel segmentation of the next slice. Results The arbitrarily shaped blood vessel boundary on each slice is segmented by using the active contour model, and the Kalman filter is employed to track the translation and shape deformation between CTA slices. The proposed algorithm is applied to the 3D visualization of chest CTA images using graphics hardware. Conclusion Through this algorithm, more opportunities, giving quick and brief diagnosis, could be provided for the radiologist before detailed diagnosis using 2D CTA slices, Also, for the surgeon, the algorithm could be used for surgical planning, simulation, navigation and rehearsal, and is expected to be applied to highly valuable applications for more accurate 3D vessel tracking and rendering.