• 대한의용생체공학회:의공학회지
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• 제18권3호
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• pp.253-259
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• 1997

Von Mises stress and compliance distribution was evaluated using a finite element analysis on the anastomosis of an artery with length of 20mm(z direction, along the horizental artery), inner diameter of 4mm, thickness fo 0.5mm and a PTFE graft with length of 5.7mm, inner diameter of 2mm, thickness of 0.2mm when anastomotic angle was $45^{\circ}$ and inner pressure of 1330 dyne/mm2 was applied inside the 2 conduits. From the analysis results were obtained as follows. (1) Artery diameter increased in both horizontal x(along the length of artery) and vertical y(perpendicular to the length of artery)directions and the magnitude of that in x direction was bigger than that in y direction. (2) The compliance was maximum on the anastomosis, especially on that with acute angle. The reduction of compliance was observed from the anastomosis area to the either right or left end. (3) The equivalent stress was maximum on top in the y direction and minimum on the nodes apart $110^{\circ}$ in circumferential direction from the top. (4) The equivalent stress was maximum in t도 vicinity of anastomosis with acute angle along the longitudinal direction of the artery. This trend was also observed along the PTFE graft.

• Journal of Gastric Cancer
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• 제19권2호
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• pp.193-201
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• 2019

Purpose: There is no consensus on the optimal method for intracorporeal esophagojejunostomy (EJ) in laparoscopic total gastrectomy (LTG). This study aims to compare 2 established methods of EJ anastomosis in LTG. Materials and Methods: A total of 314 patients diagnosed with gastric cancer that underwent LTG in the period from January 2013 to October 2016 were enrolled in the study. In 254 patients, the circular stapler with purse-string "Lap-Jack" method was used, and in the other 60 patients the linear stapling method was used for EJ anastomosis. After propensity score matching, 58 were matched 1:1, and retrospective data for patient characteristics, surgical outcome, and post-operative complications was reviewed. Results: The 2 groups showed no significant difference in age, body mass index, or other clinicopathological characteristics. After propensity score matching analysis, the linear group had shorter operating time than the circular group ($200.3{\pm}62.0$ vs. $244.0{\pm}65.5$, $P{\leq}0.001$). Early postoperative complications in the circular and linear groups occurred in 12 (20.7%) and 15 (25.9%, P=0.660) patients, respectively. EJ leakage occurred in 3 (5.2%) patients from each group, with 1 patient from each group needing intervention of Clavien-Dindo grade III or more. Late complications were observed in 3 (5.1%) patients from the linear group only, including 1 EJ anastomosis stricture, but there was no statistical significance. Conclusions: Both circular and linear stapling techniques are feasible and safe in performing intracorporeal EJ anastomosis during LTG. The linear group had shorter operative time, but there was no difference in anastomosis complications.

• Archives of Plastic Surgery
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• 제49권1호
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• pp.121-126
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• 2022

Background Although they may not replace standard training methods that use surgical microscopes, smartphones equipped with high-resolution screens and high-definition cameras are an attractive alternative for practicing microsurgical skills. They are ubiquitous, simple to operate, and inexpensive. This study compared anastomoses of chicken femoral vessels using a smartphone camera versus a standard operative microscope. Methods Forty anastomoses of non-living chicken femoral vessels were divided into four groups. A resident and an experienced microsurgeon performed anastomoses of femoral chicken vessels with 8-0 and 10-0 sutures, using a smartphone camera and a surgical microscope. The time to complete the anastomosis and the number of anastomosis errors were compared using the Mann-Whitney U test. Results The time taken to perform an anastomosis by the experienced microsurgeon was significantly longer when using the smartphone (median: 32.5 minutes vs. 20 minutes, P<0.001). The resident completed the anastomoses with both types of equipment without a significant difference in the operative times. When using a smartphone, the operation times were not significantly different between the resident and the experienced microsurgeon (P=0.238). The resident showed non-significant differences in operation time and the number of errors when using a smartphone or an operative microscope (P=1.000 and P=0.065, respectively). Conclusions Microsurgical practice with non-living chicken femoral vessels can be performed with a smartphone, though it can take longer than with an operative microscope for experienced microsurgeons. The resident may also experience frustration and tend to make more anastomosis errors when using a smartphone versus an operative microscope.

• 한국임상수의학회지
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• 제39권6호
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• pp.311-318
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• 2022

Appropriate suture technique is crucial for successful tracheal anastomosis. However, standards for an ideal suture method have not yet been established. A previous study suggested tracheal anastomosis using barbed sutures that do not require knots; however, their use in small animals has not been reported. In this study, we aimed to compare knotless barbed sutures with conventional smooth sutures in terms of maximum tensile strength and suturing time in canine tracheal models to demonstrate the feasibility of using barbed sutures in tracheal anastomosis in dogs. Tracheal segments harvested from nine beagle dog cadavers were randomly assigned to three suture groups: barbed suture (B), smooth suture in simple interrupted pattern (SI), and smooth suture in simple continuous pattern (SC). The maximum tensile force and suturing time were compared according to the suturing method, and the mode of failure was evaluated. The average suturing time was 3.29 min in the B group; 4.41 min, SC group; and 8.99 min, SI group (p < 0.001). The average maximum tensile force in the SC group was 134.97 N, which was stronger than the SI (110.57 N) and B groups (103.10 N) (p < 0.05 and p < 0.01, respectively). The difference between the B and SI groups was not significant (p = 0.05). The B group demonstrated comparable mechanical strength and shorter suture time compared with the SI group. Therefore, tracheal anastomosis using barbed sutures could be an effective alternative to conventional smooth sutures in dogs.

• Journal of Korean Neurosurgical Society
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• 제67권2호
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• pp.158-165
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• 2024

Objective : Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is conducted for flow augmentation. In this study, we measured the STA cut flow of a Korean population and evaluated the relationship between STA cut flow and long-term patency of the bypass. Methods : A retrospective study was conducted. Intraoperative measurement of STA flow was conducted using a microvascular flow meter on patients who underwent STA-MCA. After cutting the distal end, the STA flow rate was measured with no resistance and recorded. After finishing anastomosis, STA flow was measured and recorded. The cut flow index was calculated by dividing post anastomosis flow by cut flow in intracranial atherosclerotic stenosis patients. Results : The median STA cut flow was 35.0 mL/min and the post anastomosis flow was 24.0 mL/min. The cut flow of STA decreased with aging (p=0.027) and increased with diameter (p=0.004). The cut flow showed no correlation with history of hypertension or diabetes mellitus (p=0.713 and p=0.786), but did correlate a positively with history of hyperlipidemia (p=0.004). There were no statistical differences in cut flow, STA diameter, and post anastomosis flow between the frontal and parietal branches (p=0.081, p=0.853, and p=0.990, respectively). Conclusion : The median STA cut flow of a Korean population was 35 mL/min. Upon reviewing previous articles, it appears that there are differences in the STA cut flow between Western and Asian patients.

• Korean Journal of Radiology
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• 제23권1호
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• pp.52-59
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• 2022

Objective: To investigate whether the diagnostic performance of CT angiography (CTA) could be improved by modifying the conventional criterion (anastomosis site abnormality) to diagnose hepatic artery occlusion (HAO) after liver transplantation (LT) in suspected patients with Doppler ultrasound (US) abnormalities. Materials and Methods: One hundred thirty-four adult LT recipients (88 males and 46 females; mean age, 52.7 years) with suspected HAO on Doppler US (40 HAO and 94 non-HAO according to the reference standards) were included. We evaluated 1) abnormalities in the HA anastomosis, categorized as a cutoff, ≥ 50% stenosis at the anastomotic site, or diffuse stenosis at both graft and recipient sides around the anastomosis, and 2) abnormalities in the distal run-off, including invisibility or irregular, faint, and discontinuous enhancement. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the conventional (considering anastomosis site abnormalities alone) and modified CTA criteria (abnormalities in both the anastomosis site and distal run-off) for the diagnosis of HAO were calculated and compared using the McNemar test. Results: By using the conventional criterion to diagnose HAO, the sensitivity, specificity, PPV, NPV, and accuracy were 100% (40/40), 74.5% (70/94), 62.5% (40/64), 100% (70/70), and 82.1% (110/134), respectively. The modified criterion for diagnosing HAO showed significantly increased specificity (93.6%, 88/94) and accuracy (93.3%, 125/134) compared to that with the conventional criterion (p = 0.001 and 0.002, respectively), although the sensitivity (92.5%, 37/40) decreased slightly without statistical significance (p = 0.250). Conclusion: The modified criterion considering abnormalities in both the anastomosis site and distal run-off improved the diagnostic performance of CTA for HAO in suspected patients with Doppler US abnormalities, particularly by increasing the specificity.

• 대한기계학회논문집 C: 기술과 교육
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• 제1권2호
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• pp.167-177
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• 2013

최근 미세혈관 문합수술 시 봉합사 대신 기계식 문합커플러를 사용하는 수술례가 증가하고 있다. 그러나 기존의 비분해성 문합커플러는 염증반응 뿐만 아니라 수술 후 영구적으로 인체 내에 잔존한다는 한계성이 있다. 따라서 본 연구에서는 기존 비분해성 문합커플러의 한계성을 극복하기 위해 사출성형공정을 이용한 생분해성 PCL 문합커플러 제작을 채택하였다. 사출성형 공정조건 중 실린더온도와 사출압력에 따른 수축률을 계산하고 이에 따른 문합강도를 측정하였다. 그 결과 핀보다는 홀 파트의 수축률 변화가 크게 나타났다. 또한 수축률은 실린더온도가 상승할수록 증가하였으나 반대로 사출압력이 높아질수록 감소하는 경향이 나타났다. PCL 문합 커플러의 in-vitro 분해거동을 12주간 평가한 결과, 수분흡수는 증가하고 분자량은 감소하여 생체분해를 동반한 질량 및 문합강도의 감소를 확인할 수 있었다. 그러나 문합강도의 저하 수준이 전임상 요구조건을 충분히 상회하기에 PCL 문합커플러는 미세혈관수술에 적합한 후보재료임을 파악할 수 있었다.

• Journal of Gastric Cancer
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• 제15권2호
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• pp.105-112
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• 2015

Purpose: Intracorporeal anastomosis is the most difficult procedure during pure single-incision distal gastrectomy (SIDG) that affects its generalization. We introduced unaided delta-shaped anastomosis (uDelta), a novel anastomosis technique, for gastroduodenostomy after pure SIDG, and compared the results with those of previously reported Roux-en-Y anastomosis (RY). Materials and Methods: Between March 2014 and March 2015, SIDG with D1+ lymph node dissection was performed for early gastric cancer through a 2.5-cm transumbilical incision without any additional port. uDelta was performed by the operator alone, without any intracorporeal assistance. Results: uDelta was performed on 11 patents, and uncut RY was performed on 5-patients without open or multiport conversion. R0 resection was performed in all cases. No significant differences were observed in mean age and body mass index between patients who underwent uDelta or RY. Mean operation times were $214.5{\pm}36.2$ minutes for uDelta and $240.8{\pm}65.9$ minutes for RY, which was not significantly different. Reconstruction time for uDelta was shorter than that for RY, with marginal statistical significance ($26.1{\pm}8.3$ minutes vs. $38.0{\pm}9.1$ minutes, P=0.05). There were no intraoperative transfusions, 30-day mortality, or anastomosis-related complications in either group. Average length of hospital stay was $8.2{\pm}1.9$ days in the uDelta group and $7.2{\pm}0.8$ days in the RY group (P=0.320). Conclusions: After carefully considering indications, uDelta can be a feasible and can be a reproducible reconstruction method after SIDG in early gastric cancer.

• 한국임상수의학회지
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• 제18권2호
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• pp.124-132
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• 2001

The purpose of this study is to know whether single layer continuous connell suture is an acceptable alternative to simple interrupted approximating suture for end-to-end intestinal anastomosis in dogs. Fourteen mixed-breed dogs weighing 2 to 5 kg were allotted to group treated with simple interrupted approximating suture (Group I) and group treated with single layer continuous Connell suture (Group II), each of 7 dogs. All dogs in each suture pattern were compared with time for total operation ad suture elapsed for intestines to anastomose, clinical signs, changing of pre-and postoperative luminal size, status of feces, adhesion at anastomotic site for 14 days after operation. Time for total operation and suture time for intestinal anastomosis were none significant between Group I and Group II, although those in Group II was about 3 minutes shorter than those in Group I, respectively. Group I spent average 47.08${\pm}$11.10 minutes on total operation, 20.97${\pm}$5.54 minutes on suture time for intestinal anastomosis and Group II spent average 44.74${\pm}$7.77 minutes, 17.73${\pm}$3.05 minutes, respectively. All dogs were no special differences in vitality, vomiting, appetite between Group I and Group II for 14 days after operation. All dogs, except one dog in Group I, had showed normal vitality and appetite since 6~8 days after operation. Initial return of fecal passage showed in all dogs before 6 days after operation and thereafter most dogs showed normal feces. According to results, it was thought that all dogs with normal vitality and appetite before 8 days had showed good prognosis. There were no changes of intestinal luminal size in 2 dogs performed Group In and one dog performed Group II between at operation and 14 days after operation. Narrowing rate of intestinal lumen in Group I was average 9.3% of the normal diameter, whereas in Group II, 9.5% of normal diameter. In complications after operation, only one dog in Group I showed intestinal intussusception but the others didn't. Length of adhesion was measured between intestinal anastomotic site and omental graft. Length of adhesion in dogs performed Group II was mostly shorter than that of Group I. Adhesion with proximate intestines occurred in five dogs, which consisted of 3 dogs performed Group I and 2 dogs performed Group II. Concurrently, they had a great length of adhesion between anastomotic site and omental graft. There were no great differences between Group I and Group II about speed of operation, clinical signs, complications such as leakage and stricture. And all dogs performed intestinal anastomosis showed good clinical condition and prognosis. In conclusion, Single layer continuous Connell suture can safely perform an intestinal anastomosis and be an alternative of simple interrupted approximating suture in aspect of speed clinically.

• Journal of Chest Surgery
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• 제26권5호
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• pp.343-348
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• 1993

Growth of suture line and anastomosis is required for long-term success after the tracheal and bronchial surgery in infant and pediatric patient. We used various suture materials in these cases, but the results were differ. To select the adequate suture material in tracheal surgery, we tried next. Tracheal anastomoses were performed in 150 Sprague Dawley rats, aged 4 to 8 [mean 5.8] weeks and weight 62 to 106[mean 83.6] gram, to compare polydioxanone[PDS] 7-0, polyglactin 910[Vicryl]7-0, and polypropylene [prolene] 8-0 suture materials. In 150 rats, only 29[20%] were lived over 300 days, and the weight was 250 to 320[mean 289.5]gram. Cross sectional area of the anastomoses and two or three tracheal rings below anastomosis site were measured under microscope, and calculated and compared as Hsieh`s equition. Cross-sectional area,anastomosis site/normal site 100, were 89.4 $\pm$ 5.34% in PDS group[n=9], 75.7 $\pm$ 6.06% in Vicrylgroup [n = 10], and 80.8$\pm$ 4.06% in Prolene group[n = 10]. Histopathologic studies were done for all autopsies or put in death around 300 days postoperatively. PDS absorblion was not seen 16 weeks after suture but disappeared over 24 weeks slide. Vicryl absorbtion was noted postoperative 8 to 16 weeks, with marked tissue reaction. Prolene showed least tissue reaction, but the suture material was persisted with regional fibrotic capsule.Causes of death were respiratory failure in 76 cases, tracheal rupture in 22 cases, hemorrhage, biting, starvation and etc. in 23 cases. With the brief review of literatures, we report the results.