• Journal of Gastric Cancer
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• v.13 no.4
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• pp.255-262
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• 2013

Purpose: Robotic surgery for gastric cancer is a promising alternative to laparoscopic surgery, but the data are limited. We aimed to evaluate whether gaining experience in robotic gastrectomy could improve surgical outcomes in the treatment of gastric cancer. Materials and Methods: Two hundred and seven consecutive cases of patients with clinical stage I gastric cancer who underwent robotic surgery at the National Cancer Center of Korea between February 2009 and February 2012 were retrospectively reviewed. Surgical outcomes were analyzed and compared between the initial 100 and later 100 cases. Results: Seven patients required conversion to open surgery and were excluded from further analysis. The mean operating time for all patients was 248.8 minutes, and mean length of hospitalization was 8.0 days. Twenty patients developed postoperative complications. Thirteen were managed conservatively, while 6 had major complications requiring invasive procedures. One mortality occurred owing to myocardial infarction. Operating time was significantly shorter in the latter 100 cases than in the initial 100 cases (269.9 versus 233.5 minutes, P<0.001). The number of retrieved lymph nodes was significantly greater in the latter cases (35.9 versus 39.9, P=0.032). The hospital stay of patients with complications was significantly longer in the initial cases than in the latter cases (16 versus 7 days, P=0.005). Conclusions: Increased experience with the robotic procedure for gastric cancer was associated with improved outcomes, especially in operating time, lymph node retrieval, and shortened hospital stay of complicated patients. Further development of surgical techniques and technology might enhance the role of robotic surgery for gastric cancer.

• International Journal of Control, Automation, and Systems
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• v.4 no.1
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• pp.30-41
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• 2006

The goal of this work is to develop and test a robot-assisted surgery system for spinal fusion. The system is composed of a robot, a surgical planning system, and a navigation system. It plays the role of assisting surgeons for inserting a pedicle screw in the spinal fusion procedure. Compared to conventional methods for spinal fusion, the proposed surgical procedure ensures minimum invasion and better accuracy by using robot and image information. The robot plays the role of positioning and guiding needles, drills, and other surgical instruments or conducts automatic boring and screwing. Pre-operative CT images intra-operative fluoroscopic images are integrated to provide the surgeon with information for surgical planning. Some experiments employing the developed robotic surgery system are conducted. The experimental results confirm that the system is not only able to guide the surgical tools by accurately pointing and orienting the specified location, but also successfully compensate the movement of the patient due to respiration.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2005.10a
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• pp.144-148
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• 2005

The goal of this work is to develop and test a robot-assisted surgery system for spinal fusion. The system is composed of a robot, a surgical planning system, and a navigation system. It plays the role of assisting surgeons for inserting a pedicle screw in the spinal fusion procedure. Compared to conventional methods fer spinal fusion, the proposed surgical procedure ensures minimum invasion and better accuracy by using robot and image information. The robot plays the role of positioning and guiding needles, drills, and other surgical instruments or conducts automatic boring and screwing. Pre-operative CT images and intra-operative fluoroscopic images are integrated to provide the surgeon with information for surgical planning. Several experiments employing the developed robotic surgery system are conducted. The experimental results confirmed that the system is not only able to guide the surgical tools by accurately pointing and orienting the specified location, but also successfully compensate the movement of the patient due to his/her respiration.

• Journal of Chest Surgery
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• v.56 no.5
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• pp.336-345
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• 2023

Background: The objective of this study was to demonstrate the safety, efficacy, and feasibility of intraoperative monitoring of the recurrent laryngeal nerves during thoracoscopic and robotic 3-field esophagectomy. Methods: This retrospective analysis details our initial experience using intraoperative nerve monitoring (IONM) during minimally invasive 3-field esophagectomy. Data were obtained from a prospectively maintained database and electronic medical records. The study included all patients who underwent minimally invasive (video-assisted thoracic surgery/robotic) transthoracic esophagectomy with neck anastomosis. The patients were divided into those who underwent IONM during the study period and a historical cohort who underwent 3-field esophagectomy without IONM at the same institution. Appropriate statistical tests were used to compare the 2 groups. Results: Twenty-four patients underwent nerve monitoring during minimally invasive 3-field esophagectomy. Of these, 15 patients underwent thoraco-laparoscopic operation, while 9 received a robot-assisted procedure. In the immediate postoperative period, 8 of 24 patients (33.3%) experienced vocal cord paralysis. Relative to a historical cohort from the same institution, who were treated with surgery without nerve monitoring in the preceding 5 years, a 26% reduction was observed in the nerve paralysis rate (p=0.08). On follow-up, 6 of the 8 patients with vocal cord paralysis reported a return to normal vocal function. Additionally, patients who underwent IONM exhibited a higher nodal yield and a decreased frequency of tracheostomy and bronchoscopy. Conclusion: The use of IONM during minimally invasive 3-field esophagectomy is safe and feasible. This technique has the potential to decrease the incidence of recurrent nerve palsy and increase nodal yield.

• Journal of Chest Surgery
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• v.55 no.2
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• pp.168-170
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• 2022

A 58-year-old female patient was diagnosed with hypopharyngeal cancer with extension to the invasion of the upper esophagus. After 2 cycles of durvalumab as neoadjuvant therapy, total laryngo-esophagectomy using a single-port (SP) system via a subcostal incision was done. The operation was completed within 41 minutes, and the patient recovered without esophagectomy-related complications. The patient received total laryngectomy and esophagectomy using a robotic SP system via a 3-cm-long subcostal incision and gastric pull-up under laparotomy. During the postoperative period, the patient suffered from anastomotic leakage, but recovered with vacuum therapy. Here, we report the first successful human case of esophagectomy using an SP system.

• Journal of Institute of Control, Robotics and Systems
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• v.20 no.3
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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 Chest Surgery
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• v.39 no.12 s.269
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• pp.931-933
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• 2006

Robotic assisted surgery in adult patient with congenital ventricular septal defect Since December in 2005, we have done minimally invasive surgeries in selected cases of mitral valve diseases, tricuspid valve diseases, atrial septal defects and atrial fibrillations with the $AESOP^{TM}$ robotic arm. We have had a better surgical view and skill, according to accumulation of the experience of this procedure. Recently, we performed robotic assisted surgery in a 47-year-old female with congenital perimembranous ventricular septal defect.

• Journal of Chest Surgery
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• v.53 no.4
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• pp.152-159
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• 2020

Minimally invasive esophagectomy (MIE) was first introduced in the 1990s. Currently, it is a widely accepted surgical approach for the treatment of esophageal cancer, as it is an oncologically sound procedure; its advantages when compared to open procedures, including reduction in postoperative complications, reduction in the length of hospital stay, and improvement in quality of life, are well documented. However, debates are still ongoing about the safety and efficacy of MIE. The present review focuses on some of the current issues related to conventional MIE and robot-assisted MIE based on evidence from the current literature.

• Journal of Korean Neurosurgical Society
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• v.60 no.4
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• pp.385-390
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• 2017

The doctrine of informed consent, as opposed to medical paternalism, is intended to facilitate patient autonomy by allowing patient participation in the medical decision-making process. However, regrettably, the surgical informed consent (SIC) process is invariably underestimated and reduced to a documentary procedure to protect physicians from legal liability. Moreover, residents are rarely trained in the clinical and communicative skills required for the SIC process. Accordingly, to increase professional awareness of the SIC process, a brief history and introduction to the current elements of SIC, the obstacles to patient autonomy and SIC, benefits and drawbacks of SIC, planning of an optimal SIC process, and its application to cases of an unruptured intracranial aneurysm are all presented. Optimal informed consent process can provide patients with a good comprehension of their disease and treatment, augmented autonomy, a strong therapeutic alliance with their doctors, and psychological defenses for coping with stressful surgical circumstances.

• Journal of Yeungnam Medical Science
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• v.21 no.1
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• pp.1-11
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• 2004

Total knee arthroplasty has become a common procedure for treatment of severe osteoarthritis, rheumatoid arthritis and post-traumatic arthritis. In the past, failure of total knee arthroplasty was commonly attributable to aseptic loosening, often associated with component malalignment, soft tissue imbalance. With improved surgical instrumentation and soft tissue balancing techiniques, failure secondary to mechanical loosening has been minimal. But surgeons are still dissatisfied with implant malalignment. Correct tibiofemoral alignment seems to be particularly important since it is generally agreed that axial deviation and imprecise implantation may lead to loosening of the implant component. Navigation systems and robotic techniques could potentially solve problems of imprecision in traditional total knee arthroplasty. It is expected that the success rate and longevity of total knee arthroplasty will be improved during the twenty first century.