• Archives of Plastic Surgery
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• v.44 no.4
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• pp.293-300
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• 2017

Background Simulation training is becoming an increasingly important component of skills acquisition in surgical specialties, including Plastic Surgery. Non-living simulation models have an established place in Plastic Surgical microsurgery training, and support the principles of replacement, reduction and refinement of animal use. A more sophisticated version of the basic chicken thigh microsurgery model has been developed to include dissection of a type 1-muscle flap and is described and validated here. Methods A step-by-step dissection guide on how to perform the chicken thigh adductor profundus free muscle flap is demonstrated. Forty trainees performed the novel simulation muscle flap on the last day of a 5-day microsurgery course. Pre- and post-course microvascular anastomosis assessment, along with micro dissection and end product (anastomosis lapse index) assessment, demonstrated skills acquisition. Results The average time to dissect the flap by novice trainees was $82{\pm}24$ minutes, by core trainees $90{\pm}24$ minutes, and by higher trainees $64{\pm}21$ minutes (P=0.013). There was a statistically significant difference in the time to complete the anastomosis between the three levels of training (P=0.001) and there was a significant decrease in the time taken to perform the anastomosis following course completion (P<0.001). Anastomosis lapse index scores improved for all cohorts with post-test average anastomosis lapse index score of $3{\pm}1.4$ (P<0.001). Conclusions The novel chicken thigh adductor profundus free muscle flap model demonstrates face and construct validity for the introduction of the principles of free tissue transfer. The low cost, constant, and reproducible anatomy makes this simulation model a recommended addition to any microsurgical training curriculum.

• Archives of Plastic Surgery
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• v.42 no.2
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• pp.159-163
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• 2015

Background Interest in global health and international mission trips among medical student and resident trainees is growing rapidly. How these electives and international mission experiences affect future practice is still being elucidated. No study has identified if participation in international surgical missions during residency is a predictor of participation in international surgical missions in practice after training completion. Methods All trainees of our plastic surgery residency program from 1990 to 2011, during the implementation of optional annual international surgical missions, were surveyed to determine if the graduate had gone on a mission as a resident and as a plastic surgeon. Data were compared between graduates who participated in missions as residents and graduates who did not, from 1990 to 2011 and 1990 to 2007. Results Of Plastic Surgery graduates from 1990 to 2011 who participated in international missions as residents, 60% participated in missions when in practice, versus 5.9% of graduates participating in missions in practice but not residency (P<0.0001). When excluding last 5 years, graduates participating in international missions in practice after doing so as residents increases to 85.7%, versus 7.41% who participate in practice but not residency P<0.002. Conclusions Results reveal plastic surgeons who participate in international surgical missions as residents participate in international surgical missions in practice at higher rates than graduates who did not participate in missions during residency. International missions have significant intrinsic value both to trainee and international communities served, and this opportunity should be readily and easily accessible to all plastic surgery residents nationwide.

• Quality Improvement in Health Care
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• v.27 no.1
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• pp.51-57
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• 2021

As expectations for medical service have increased recently, the interest in medical quality improvement and patient safety has increased. In addition, as part of efforts to improve the training environment of the residents, the working hours of the residents are reduced which means that the medical workforce is expected to change significantly in the future. As a result, in hospital care of surgical patients, it is inevitable to change the patient care system by surgeon-residents to the new system. For this, the introduction of a surgical hospitalist system is proposed as an alternative. This article is an introduction to the process of introducing a surgical hospitalist system in a single institution and describes in detail the considerations This is the first case of the introduction of surgical hospitalist in Korea. Through this case, we intend to lay the groundwork for the successful implementation of the surgical hospitalist in Korea.

• Journal of Biomedical Engineering Research
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• v.44 no.3
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• pp.211-217
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• 2023

Recently, many studies have introduced artificial intelligence systems in the surgical process to reduce the incidence and mortality of complications in patients. Bleeding is a major cause of operative mortality and complications. However, there have been few studies conducted on detecting bleeding in surgical videos. To advance the development of deep learning models for detecting intraoperative hemorrhage, three models have been trained and compared; such as, YOLOv5, RetinaNet50, and RetinaNet101. We collected 1,016 bleeding images extracted from five surgical videos. The ground truths were labeled based on agreement from two specialists. To train and evaluate models, we divided the datasets into training data, validation data, and test data. For training, 812 images (80%) were selected from the dataset. Another 102 images (10%) were used for evaluation and the remaining 102 images (10%) were used as the evaluation data. The three main metrics used to evaluate performance are precision, recall, and false positive per image (FPPI). Based on the evaluation metrics, RetinaNet101 achieved the best detection results out of the three models (Precision rate of 0.99±0.01, Recall rate of 0.93±0.02, and FPPI of 0.01±0.01). The information on the bleeding detected in surgical videos can be quickly transmitted to the operating room, improving patient outcomes.

• Journal of Chest Surgery
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• v.54 no.3
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• pp.214-217
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• 2021

In rare cases, levoatrial cardinal vein may occur as an isolated condition without additional congenital anomalies. Depending on the direction and flow of the shunt, this pathology may produce symptoms; alternatively, it may be asymptomatic, as in the case presented in this study. In asymptomatic cases, complications, such as paradoxical embolism and brain abscess, can arise later. In the 11-year-old patient whose case is presented here, the levoatrial cardinal vein was asymptomatic and incidentally detected. The percutaneous closure method was applied first. However, by 16 hours after the procedure, the occluder device had embolized to the iliac artery. Emergency surgery was performed; first, the occluder device was removed, and levoatrial cardinal vein ligation was then performed via a mini-thoracotomy. The symptoms, diagnosis, and treatment modalities of isolated levoatrial cardinal vein are discussed in the context of this case described herein.

• Archives of Plastic Surgery
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• v.50 no.2
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• pp.220-221
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• 2023

Microsurgical peripheral nerve repair is a technical and challenging procedure that requires thorough training prior to a real-life operating theater scenario. While the gold standard in training remains training on biological living peripheral nerve specimen, various inanimate models of nerve repair simulation have been described in the past years. The textile elastic band (TEB) obtained from a surgical mask was either covered with a fine silicone sheath or was left bare and was used afterward for end-to-end coaptation. The average diameter of the TEB was 2 mm, similar with the nerves in the distal hand and can be easily crafted out of accessiblematerials such as a surgicalmask and silicone sealant. The silicone that covers the TEB offers more fidelity to the simulation for microsurgical nerve coaptation. The TEB model offers an affordable, available, and easy-to-craft alternative to the existing models for peripheral nerve repair simulation and serves as a good initiation tool before moving on to biological specimens.

• Archives of Plastic Surgery
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• v.41 no.3
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• pp.201-208
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• 2014

Microsurgery is a precise surgical skill that requires an extensive training period and the supervision of expert instructors. The classical training schemes in microsurgery have started with multiday experimental courses on the rat model. These courses have offered a low threat supervised high fidelity laboratory setting in which students can steadily and rapidly progress. This simulated environment allows students to make and recognise mistakes in microsurgery techniques and thus shifts any related risks of the early training period from the operating room to the lab. To achieve a high level of skill acquisition before beginning clinical practice, students are trained on a comprehensive set of exercises the rat model can uniquely provide, with progressive complexity as competency improves. This paper presents the utility of the classical rat model in three of the earliest microsurgery training centres and the new prospects that this versatile and expansive training model offers.

• Journal of Korean Clinical Nursing Research
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• v.18 no.1
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• pp.99-110
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• 2012

Purpose: The purpose of this study was to examine the puncture incidence of surgical gloves in an operational setting. Methods: The 277 surgical gloves were used collecting at one general hospital located in Seoul from February 1, 2011 to April 3. The data were analyzed by $x^2$ test, Fisher's exact test, and multiple logistic regression. Results: In the dental and orthopedic department, the puncture incidence were significantly higher than others. The time of wearing gloves demonstrated significant difference: The group 181-240 minutes had a significantly higher than those with under 90, 91-180, or over 240 minutes. The influencing factors were as follows. Compared to that of the 2nd assistants, the puncture incidence rates of the surgeons were 9.91 times, scrub nurses were 8.39 times higher respectively. The participants in work experience under 1 year showed a 4.58 times higher than those with over 7 years. In addition, compared to the puncture incidence rate of neurosurgery department, the 17.41 times in cardio-thoracic surgery, 13.89 times in dental surgery, 4.93 times in gynecology, and 4.97 times in orthopedics higher respectively. Conclusion: There is a need for training operational room personnels to occasionally exchange the gloves even during the procedure and to use double surgical gloves.

• Clinics in Shoulder and Elbow
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• v.19 no.2
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• pp.110-116
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• 2016

Background: Arthroscopic surgical repair is a better intervention than non-operative (conservative) treatment for patients with shoulder dislocations. This systematic review determined the numbers-needed-to-treat (NNT) and relative risk reduction (RRR) associated with arthroscopic surgical repair versus non-operative treatment in reducing recurrence rates among patients with first-time traumatic anterior shoulder dislocations. Methods: We searched Google Scholar, MEDLINE, SPORTDiscus, and CINAHL from inception in 2015. All articles had to compare arthroscopic surgical repair and non-operative treatment and be written in English. We used the total number of subjects and the number of recurrent dislocations within each treatment to calculate the NNT and RRR for each study and the pooled data. Results: Six articles were selected and all clearly demonstrated that the arthroscopic surgical repair was more effective than non-operative treatment in reducing the recurrence episodes. The pooled NNT was 1.76 (95% confidence interval [CI]=NNT to benefit 1.50-2.13) and the pooled RRR was 86.0% (95% CI=77.0%-92.0%) among individuals who underwent arthroscopic repair. The average follow-up time was 56 months. Conclusions: A Strength of Recommendation Taxonomy level of evidence of 1 with a grade A recommendation supports the use of arthroscopic surgical repair over non-operative treatment in prevention of first-time traumatic anterior shoulder dislocations. We suggest that sports medicine practitioners consider the patients' age, occupation, and physical activity level when making a clinical decision.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.3
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• pp.1213-1217
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• 2015

Background: Gastric cancer is the second most common cause of cancer- related deaths worldwide and ranks $11^{th}$ or $14^{th}$ among all deaths. Patients with advanced disease require supportive care along with the medical and/or surgical treatment. Aim: To assess the need for palliative care for patients with advanced tumours along with standard clinical therapy. Materials and Methods: Eighty-four patients with metastatic (stage 4) gastric cancer, including both patients who had received surgical treatment or not, were followed up in Bagcilar Training and Research Hospital, Division of Medical Oncology between 2011 and 2014. They were categorised as supportive care (-) (Group 1, n=37) and (+) groups (Group 2, n=47) and evaluated retrospectively. Results: Demographic characteristics of the patients were as follows: mean age, Group 1, $65.2{\pm}10.5$ years, Group $2,63.7{\pm}11.3$ years; male/female ratio, Group 1, 21/16, Group 2, 28/19; distribution of Eastern Cooperative Oncology Group (ECOG) performance scores of 0 and 1, Group 1, ECOG 0 (n=9) and 1 (n=14), Group 2, ECOG 0 (34) and 1 (n=13) (p<0.0001); patients receiving second-line, Group 1 (n=7) and Group 2 (n=22) (p<0.008) or third - line chemotherapy,Group 2 (n=6) (p<0.02); mortality rates, Group 1, (n=28; 75.6%) and Group 2 (n=30; 63.8%); progression-free survival (PFS) rates, Group 1, $17.4{\pm}6$ weeks, Group 2, $28.3{\pm}16.2$ weeks; statistically significant overall survival rates, Group 1, $20.8{\pm}8.2$ weeks and Group 2, $28.3{\pm}162$ weeks (p<0.01). Conclusions: The supportive care team (medical oncologist, general surgeon, internal medicine specialist, algologist, psychiatrist and radiologist) can play a role in the treatment of metastatic gastric tumours, with improvements shown in terms of the performance status of cases, eligibility of patients to be on chemotherapy programmes for longer duration and overall survival rates in Turkey.