• Journal of Chest Surgery
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• 제54권1호
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• pp.68-71
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• 2021

A 37-year-old man was transferred to our level I trauma center after a road traffic accident, presenting with right acetabular fracture, multiple rib fractures, epidural hemorrhage, and liver contusion. Severe traumatic tricuspid regurgitation was also discovered during the work-up for surgery. Our initial attempt at acetabular surgery failed when the patient experienced near cardiac arrest during anesthetic induction. It was hence decided that tricuspid valve repair should precede orthopedic surgery. Minimally invasive tricuspid valve repair using the double orifice technique was successfully performed. Subsequently, acetabular surgery was performed and he was discharged 35 days post-trauma without any complications.

• Journal of Chest Surgery
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• 제55권1호
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• pp.98-100
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• 2022

Unilateral pulmonary edema after minimally invasive cardiac surgery is a rare, but potentially life-threatening condition. However, the exact causes of unilateral pulmonary edema remain unclear. We experienced aggressive unilateral pulmonary edema followed by redo-resection of recurrent left atrial myxoma through a right mini-thoracotomy. Intraoperative veno-venous extracorporeal membrane oxygenation was applied after the termination of cardiopulmonary bypass, and separate mechanical ventilation using a double-lumen endotracheal tube was applied after surgery. The patient was successfully treated and discharged uneventfully.

• Journal of Gastric Cancer
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• 제23권1호
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• pp.159-170
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• 2023

Maintaining the postoperative quality of life (QOL) while ensuring curability without overtreatment is important in the treatment of early gastric cancer. Postoperative QOL is anticipated to be maintained through minimally invasive function-preserving gastrectomy in early gastric cancer. The concept of the sentinel lymph node (SN) basin is essential to maintain the curability of early gastric cancer using minimally invasive function-preserving gastrectomy. However, additional resection after surgery is difficult to perform in gastric cancer. Thus, the SN basin theory is important. Recently, a multicenter randomized phase III trial in South Korea (SENORITA trial) proved that laparoscopic sentinel node navigation surgery (LSNNS) for stomach preservation results in better postoperative QOL compared with standard gastrectomy in patients with early gastric cancer. LSNNS contributes to patients' QOL based on the concept that curability is not impaired. A multicenter nonrandomized phase III trial is ongoing in Japan, and oncologic safety is expected to be demonstrated. LSNNS has been established as a treatment option for selected patients with early gastric cancer, and its application will become widespread in the future.

• Journal of Chest Surgery
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• 제40권12호
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• pp.825-830
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• 2007

배경: 최소 침습적 심장 수술은 전통적인 정중 흉골 절개술에 비해 수술 후 조기 회복 및 우수한 미용적 효과 등의 장점이 있지만 승모판막 성형술과 같이 복잡한 개심술에서의 성적은 아직 국내에 보고된 바 없다. 본 연구에서는 승모판 폐쇄 부전증의 환자군에서 로봇을 이용한 최소 침습적 승모판 성형수술의 유용성에 관해 정중 흉골 절개술과 비교하여 알아보고자 하였다. 대상 및 방법: 1993년 12월부터 2005년 12월까지 승모판막 폐쇄 부전으로 승모판막 성형술을 시행받은 520명의 환자를 연구대상으로 하였다. 이 중 정중 흉골 절개술을 통하여 승모판 성형술을 시행한 군을 S군(n=432), 최소 침습적 우측 개흉술을 이용한 환자군을 M군(n=88)으로 하여 임상 결과를 비교하였다. 우측 개흉술시에는 AESOP (Automated Endoscopic System for Optimal Positioning) 3000이라는 로봇을 이용하여 5 cm 이하의 절개로 수술을 시행하였다. 결과: 양 군 간의 나이, 성별, 수술 전 좌심실 구출률 등은 양 군 간의 차이는 없었다. S군에서 2예의 조기 사망이 있었으나 M군에서는 수술 사망예가 없었다. M군이 대동맥 차단 시간과 심폐기 가동 시간은 S군에 비해 유의하게 길었지만, 중환자실 재원기간과 수술 후 재원 일수는 S군에 비해 유의하게 짧았다. 제한된 절개에도 M군에서 승모판막 성형술식에 사용된 수술 술기는 제한이 없었으며, 술 후 의미있는 잔존 승모판막 폐쇄부전증의 빈도는 양 군에서 유사하였다 결론: 최소 침습적 우측 개흉술을 통한 승모판막 성형술을 시행하더라도 조기 성적은 차이가 없었다. 향후 최소 침습적 승모판막 성형술의 중-장기 성적의 관찰을 요하며 본 연구를 바탕으로 승모판막 성형술의 일차적인 접근 방법으로 최소 침습적 개흉술이 보다 폭넓게 시행될 수 있을 것으로 기대한다.

• Journal of Gastric Cancer
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• 제13권2호
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• pp.98-105
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• 2013

Purpose: The aim of this study is to investigate the clinical factors affecting on the cure rate by invasive and open surgery for gastric cancer and to establish a subgroup of patients who can be applied by the early recovery after surgery program through this retrospective analysis. Materials and Methods: In this retrospective study, we analyzed 425 patients who underwent gastric cancer surgery between January 2011 and December 2011 and were managed with conventional clinical therapies. This clinical algorithm was made when the patient was in minimally invasive surgery group and discharged from hospital one day faster than them in open surgery group. Results: The completion rate of the clinical pathway was 62.4%. Despite the different applications of clinical pathway, completion rate in minimally invasive surgery group was significantly higher than that of open group (P<0.001). In multivariate analysis, the surgical procedure of minimally invasive surgery (odds ratio=4.281) was the most predictable factor to complete clinical pathway. Additionally, younger patients (odds ratio=1.933) who underwent distal gastrectomy (odds ratio=1.999) without combined resection (odds ratio=3.069) were predicted to accomplish the clinical pathway without any modifications. Conclusions: We concluded that high efficacy of the clinical pathway for gastric cancer surgery was expected to selected patients through retrospective analysis (expected completion rate=85.4%). In addition, these patients would become enrolled criteria for early recovery program in gastric cancer surgery.

• Journal of Chest Surgery
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• 제39권2호
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• pp.171-175
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• 2006

최소 침습성 흉부수술은 최근에 가장 발전되어온 중요한 수술의 한 분야이다. 선천성 낭종성 선종양 기형은 비교적 드물게 발생하는 폐질환으로 누두흉, 선천성 심장 및 폐혈관 질환 같은 여러 가지 선천성 기형 등이 동반될 수 있다. 저자들은 우하엽 폐에 선천성 낭종성 선종양 기형이 있으며 누두흉이 동반된 5세 된 남아 환자를 최소 침습적인 방법으로 치료 경험하였다. 저자들은 흉강경을 이용하여 우하엽 폐절제술을 실시하였고, 동시에 누두흉에 대해서는 흉골 하 금속막대를 이용한 너스 술식으로 교정하였다. 이와 같이 이러한 질환에 대한 최소 침습적인 수술방법은 유용하고 미용적으로 우수하다.

• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.247-253
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• 2001

Objective : In general, to perform posterior lumbar interbody fusion(PLIF), it has been used more invasive procedure than simple discectomy. However we try to perform PLIF with TFC with smaller invasion almost same as in simple discectomy. This study is about its procedure and clinical results. Materials and Methods : The authors retrospectively analyzed 43 cases of minimally invasive PLIF with TFC from July 1998 to May 2000. Operative procedure, operative complication, change of disc height, blood loss, ambulation time, hospitalization period, clinical success rate, and bony fusion rate were analyzed. Results : 40 patients were capable to walk on the 2nd day of the post-operation. The average hospitalization period is 5.6 days. The average blood loss was 0.19L/level with no transfusion or wound drainage. The height of disc changed from 8.84mm to 13.54mm. Clinical success rate is 95% when evaluated by the Prolo's scale. The complication was delayed wound infection(2) and transient paresthesis(1). The bony fusion was shown in 17 patients (94.4%) out of 18 patients who passed one year. Conclusion : As a result of minimally invasive PLIF, pain was decreased and early ambulation and short hospitalization was possible. Complication was similar or lower than other studies, and the bony fusion rate and clinical success rate were also similar during follow-up.

• Journal of Chest Surgery
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• 제32권5호
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• pp.438-441
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• 1999

배경: 최소 침습성 심장수술은 기존의 정중 흉골절개술보다 우수한 미용효과, 흉곽 개폐에 있어서의 용이함, 작은 외상에 따른 통증, 감염, 출혈 등의 감소, 빠른 회복 및 재원일수의 감소 등이 장점으로 제시되면서 점차 널리 시행되고 있다. 대상 및 방법: 저자들은 1997년 3월부터 12월 까지 36명의 환자를 대상으로 우측 방정중 절개법, 흉골횡 절개법, 최소흉골절개법 등의 3가지 접근방법으로 대동맥 판막 및 승모판 판막질환, 선천성 심기형의 환자 등에 대해 최소 침습성 심장수술을 시행하였다. 결과: 사망례는 없었다. 합병증으로는 술후 부정맥 4례, 출혈로 인한 재수술 1례, 창상 지연유합 1례가 있었다. 사용된 창상의 평균 길이는 9.1$\pm$0.9cm이었고 중환자실 체류기간은 평균 48$\pm$29시간, 술후 재원기간은 평균 10$\pm$7일 이었다. 결론: 술중 제세동, 탈기, 심장감압 등의 과정에 있어서 어려운 점이 있고 아직까지는 선별된 예에 한해 시행되고 있으나 경험의 축적에 따라 점차 그 적용례가 늘어날 것이라 전망된다.

• 대한족부족관절학회지
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• 제24권2호
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• pp.87-93
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• 2020

Purpose: This study evaluated the clinical results of surgical treatment with minimally invasive plate osteosynthesis for treating displaced intra-articular fractures of the calcaneus in comparison with conventional lateral extensile approach plate osteosynthesis. Materials and Methods: Of 79 cases of Sanders type II or III calcaneus fractures, 15 cases treated with the minimally invasive calcaneal plate (group M) and 64 cases treated with lateral extensile approach calcaneal plate (group E) were identified. After successful propensity score matching considering age, sex, diabetes mellitus history, and Sanders type (1:3 ratio), 15 cases (group M) and 45 cases (group E) were matched and the demographic, radiologic, and clinical outcomes were compared between the two groups. Results: The median time of surgery from injury was 2.0 days in group M and 6.0 days in group E (p=0.014). At the six months follow-up, group M showed results comparable with those of group E in radiographic outcomes. In the clinical outcomes, group M showed better postoperative American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores than did group E (p=0.001, p=0.008). A greater range of subtalar motion was achieved at the six months follow-up in group M (inversion 20.0° vs. 10.0°, p=0.002; eversion 10.0° vs. 5.0°, p=0.025). Although there were no significant differences in complications between the two groups (1 [6.7%] vs. 7 [15.6%], group M vs. group E; p=0.661), there was only one sural nerve injury and no wound dehiscence and deep infection in group M. Conclusion: Minimally invasive plate osteosynthesis showed superior clinical outcomes compared with that of the conventional lateral extensile approach plate osteosynthesis in Sanders type II or III calcaneus fractures. We suggest applying minimally invasive plate osteosynthesis in Sanders type II or III calcaneus fractures.

• Journal of Chest Surgery
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• 제45권2호
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• pp.80-84
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• 2012

Background: The aim of this study is to evaluate our institutional results of the aortic valve replacement through minimally invasive approaches compared with conventional sternotomy. Materials and Methods: From August 1997 to July 2010, 838 patients underwent primary isolated aortic valve replacement. Of them, 73 patients underwent surgery through minimally invasive approaches (MIAS group) whereas 765 patients underwent surgery through the conventional sternotomy (CONV group). Clinical outcomes were compared using a propensity score matching design. Results: Propensity score matching yielded 73 pairs of patients in which there were no significant differences in baseline profiles between the two groups. Patients in the MIAS group had longer aortic cross clamp than those in the CONV group ($74.9{\pm}27.9$ vs.. $66.2{\pm}27.3$, p=0.058). In the MIAS group, conversion to full sternotomy was needed in 2 patients (2.7%). There were no significant differences in the rates of low cardiac output syndrome (4 vs. 8, p=0.37), reoperation due to bleeding (7 vs. 6, p=0.77), wound infection (2 vs. 4, p=0.68), or requirements for dialysis (2 vs. 1, p=0.55) between the two groups. Postoperative pain was significantly less in the MIAS group than the conventional group (pain score, $3.79{\pm}1.67$ vs. $4.32{\pm}1.56$; p=0.04). Conclusion: Both minimally invasive approaches and conventional sternotomy had comparable early clinical outcomes in patients undergoing primary isolated aortic valve replacement. Minimally invasive approaches significantly decrease postoperative pain.