• Journal of Veterinary Clinics
• /
• v.39 no.6
• /
• pp.319-325
• /
• 2022

Two-port laparoscopic ovariectomy (Lap-OVE) has been performed in small dogs, using 3-mm and 5-mm portal sites, and is associated with reduced surgical stress and postoperative pain. However, extension of the incision is often needed to extract the ovaries. In this study, we aimed to minimize invasiveness by using smaller-sized cannulas as well as a novel technique for ovary extraction. Lap-OVE was performed on six, healthy female dogs (range, 3 to 7.2 kg) using two 3-mm midline portals. The middle finger of a size M nitrile glove was cut at its base and sterilized preoperatively. The ovary was suspended at the body wall using a 1-0 blue nylon needle, and the ovarian pedicle and ligaments were transected using a 3-mm bipolar forceps. To facilitate the glove passing through the 3.9-mm port, it was turned inside out to expose the smooth inner surface, before being inserted into the abdominal cavity with an applicator. Both ovaries were placed inside, and the mouth of the glove was exteriorized through the port with a laparoscopic grasping forceps. The ovaries were morcellated inside the glove, using Adison-Brown tissue forceps and iris scissors, which enabled safe extraction without incision enlargement. Median incision lengths were 4.3 mm (3.5-mm cranial cannula) and 4.8 mm (3.9-mm caudal cannula). An advantage of this procedure was that there was no need for skin sutures. In conclusion, using our novel technique, sutureless Lap-OVE was possible in small dogs using two 3-mm portal sites without additional incision.

• Journal of Chest Surgery
• /
• v.57 no.4
• /
• pp.371-379
• /
• 2024

Background: Sutureless valves are widely used in aortic valve replacement surgery, with Perceval valves and Intuity valves being particularly prominent. However, concerns have been raised about postoperative thrombocytopenia with Perceval valves (Corcym, UK). We conducted a comparative analysis with the Intuity valve (Edwards Lifesciences, USA), and assessed how thrombocytopenia affected patient and transfusion outcomes. Methods: Among 595 patients who underwent aortic valve replacement from June 2016 to March 2023, sutureless valves were used in 53 (Perceval: n=23; Intuity: n=30). Platelet counts were monitored during hospitalization and outpatient visits. Daily platelet count changes were compared between groups, and the results from patients who underwent procedures using Carpentier Edwards Perimount Magna valves were used as a reference group. Results: Compared to the Intuity group, the Perceval group showed a significantly higher amount of platelet transfusion (5.48±1.64 packs vs. 0.60±0.44 packs, p=0.008). During the postoperative period, severe thrombocytopenia (<50,000/μL) was significantly more prevalent in the Perceval group (56.5%, n=13) than in the Intuity group (6.7%, n=2). After initial postoperative depletion, daily platelet counts increased, with significant differences observed in the extent of improvement between the Perceval and Intuity groups (p<0.001). However, there was no significant difference in early mortality or the incidence of neurological complications between the 2 groups. Conclusion: The severity of postoperative thrombocytopenia differed significantly between the Perceval and Intuity valves. The Perceval group showed a significantly higher prevalence of severe thrombocytopenia and higher platelet transfusion volumes. However, thrombocytopenia gradually recovered during the postoperative period in both groups, and the early outcomes were similar in both groups.

• Journal of Chest Surgery
• /
• v.18 no.2
• /
• pp.305-313
• /
• 1985

Surgical therapy for dissection of the aorta has had a high mortality. One contributing factor has been hemorrhage from the prosthesis and the suture lines. Recently, a new method of treatment with an intraluminal graft that requires no end-to-end anastomosis has been developed. Of the four patients with dissecting aneurysm of the aorta treated by inserting sutureless ringed intraluminal graft at the Department of Thoracic and Cardiovascular Surgery, S.N.U.H., three were DeBakey type I [one with associated aortic insufficiency] and the other was DeBakey type III. Suspected etiology of the dissection was Marfan`s syndrome in one and hypertension in the others. Total cardiopulmonary bypass was utilized in repairing dissecting aneurysms of the ascending aorta [type A] and simple aortic crossclamping was used for the patient with dissecting aneurysm of the descending aorta. The basic technique consists of inserting the whole ringed graft into the true lumen of the dissected aorta and circumferentially ligating the aorta against the groove in the rings. The proximal ring of the graft effectively stabilized the flail aortic valve in patient with aortic insufficiency associated with dissection of the ascending aorta. There were no hospital deaths and one patient with type III dissecting aneurysm developed postoperative paraparesis and renal insufficiency which was resolved. Follow-up has been from 1 month to 16 months with no evidence of prosthetic problems, such as erosion, migration, or thrombosis.

• Journal of Chest Surgery
• /
• v.51 no.1
• /
• pp.1-7
• /
• 2018

Background: Sutureless aortic valve replacement (SU-AVR) has been developed as an alternative surgical treatment for patients with symptomatic severe aortic stenosis (AS). The aim of this study was to evaluate the clinical outcomes of SU-AVR through an assessment of hemodynamic performance and safety. Methods: From December 2014 to June 2016, a total of 12 consecutive patients with severe AS underwent SU-AVR. The endpoints were overall survival and valve-related complications (paravalvular leakage, valve thrombosis, migration, endocarditis, and permanent pacemaker implantation). The mean follow-up duration was $18.1{\pm}8.6months$. Results: The mean age of the patients was $77.1{\pm}5.8years$ and their mean Society of Thoracic Surgeons score was $9.2{\pm}17.7$. The mean cardiopulmonary bypass and aortic cross-clamp times were $94.5{\pm}37.3$ minutes and $54.9{\pm}12.5minutes$, respectively. Follow-up echocardiography showed good prosthesis function with low transvalvular pressure gradients (mean, $13.9{\pm}8.6mm\;Hg$ and peak, $27.2{\pm}15.0mm\;Hg$) at a mean of $9.9{\pm}4.2months$. No cases of primary paravalvular leakage, valve thrombosis, migration, or endocarditis were reported. A new permanent pacemaker was implanted in 1 patient (8.3%). The 1-year overall survival rate was $83.3%{\pm}10.8%$. Conclusion: Our initial experience with SU-AVR demonstrated excellent early clinical outcomes with good hemodynamic results. However, there was a high incidence of permanent pacemaker implantation compared to the rate for conventional AVR, which is a problem that should be solved.

• Journal of The Korean Ophthalmological Society
• /
• v.59 no.12
• /
• pp.1185-1189
• /
• 2018

Purpose: We report a rare case of isolated traumatic aniridia in a pseudophakic eye. Case summary: A 69-year-old female came to our emergency department complaining of right eye pain and visual disturbance after trauma due to fall on the stairs. Five years earlier she had undergone an uncomplicated right sutureless phacoemulsification cataract extraction through a 2.2 mm temporal clear corneal incision, followed by insertion of a folding intracapsular intraocular lens. Total iris expulsion occurred through the cataract incision without extension of the wound or disruption of the posterior capsule or intraocular lens. Conclusions: We report a rare case of isolated traumatic aniridia in a pseudophakic eye, which has not been reported in the Republic of Korea.

• Journal of Chest Surgery
• /
• v.7 no.2
• /
• pp.189-200
• /
• 1974

The mitral valve replacement with Beall prosthetic valve was performed on three patients, and double valve replacement. aortic and mitral valve, was performed in this department.1) The preoperative studies about the first case were compatible with mitral steno-insufficency.The diseased mitral valve was replaced with the medium sized Beall prosthetic valve under the cardiopulmonary hypass using hypothermic hemodilution technique. The total perfusion time was eighty minutes. Immediate postoperative course was smooth, but this patient was died of asphyxia due to tracheomalacia complicated after tracheostomy 3 months after operation. Autopsy on this patient revealed that no thrombus and no ball variance could be found, and endothelization on the valve cuff was satisfactory. 2) The preoperative studies on the second case were compatible with mitral insufficiency. The diseased mitral valve was replaced with the medium sized Beall prosthetic valve under the cardiopulmonary bypass using hypothermic hemodilution technigue. The total perfusion time was 123 minutes. This patient was discharged in good condition and follow-up study after 16 months revealed the patient had enjoyed healthy life. 3) The preoperative studies about the third case were compatible with aortic insufficiency and mitral stenoinsufficiency. The diseased valves were replaced with type 2 sutureless Magovern aortic valve and the medium sized Beall mitral prosthesis under cardiopulmonary bypass using hypothermic hemodilution technIque and coronary artery perfusion. The total perfusion time was 155 minutes. This patient was discharged in good condition, but thromboembolism was developed 2 months after discharge. 4) The preoperative studies about the fourth case were compatible with mitral insufficiency. The diseased mitral valve was replaced with the medium sized Beall prosthetic valve. The total perfusion time was 132 minutes. The atrioventricular block developed just after operation but converted to normal sinus rhythmn on the third postperative day. The preoperative NYHA functional classification IV was converted to Class 1 or 11 at the time of discharge and this patient enjoyed healthy life. Attendum; The fifth case, nineteen years old male with mital insufficiency underwent Beall valve replacement and his course was uneventful 2 weeks after operation.

• Journal of Chest Surgery
• /
• v.21 no.3
• /
• pp.497-509
• /
• 1988

Current therapy of aortic dissections remains unstandardized because of the relative rarity of these catastrophic events and conflicting reported results of various therapeutic strategies. Hence, we reviewed our current results and planned to purify our method of interpretation of results and so, to standardize therapeutic managements. This study comprised unselected, consecutive 27 patients with aortic dissections who were operated at Seoul National University Hospital from Jan 1983 to March 1988. The results from analysis of their preoperative, operative and postoperative finding were as follows: 1] 7 patients had acute type A, 14 had chronic type A, 4 had acute type B, and 2 had chronic type B. 2] The causes of dissections were unclear, but 8 patients had Marfan`s syndromes, 2 had previous operative histories on cardiovascular systems and 2 had congenital heart diseases. 3] Multiple preoperative variables were found to correlate significantly with operative mortality and complications. The prevalences of such preoperative major complicating factors were significantly more frequent in acute than chronic [P < 0.05] and type A than type B [P < 0.01]. 4] Operations were performed according to the type of the dissections and whether it was acute or chronic. Usually dacron tube graft replacements were performed[25/26]. Intraluminal sutureless graft replacement was performed in 11 patients. Of the 14 patients with combined aortic regurgitation, concomitant aortic valve resuspension in 4, seperative aortic valve replacement in 1, and aortic valve replacement with coronary reimplantation were performed in 9 patients. 2 patients had concomitant arch vessel managements. 5] Over-all operative mortality rate was 33% and 54% for acute type A, 25% for acute type B, 29% for chronic type A, 0% for chronic type B respectively. The main causes of operative mortality were cardiovascular complications [mainly CPB-weaning failure] in acute cases and hemorrhagic complications in chronic cases.

• The Korean Journal of Pain
• /
• v.28 no.4
• /
• pp.244-253
• /
• 2015

Background: Although circumcision for phimosis in children is a minor surgical procedure, it is followed by pain and carries the risk of increased postoperative anxiety. This study examined predictive factors of postoperative pain and anxiety in children undergoing circumcision. Methods: We conducted a prospective cohort study of children scheduled for elective circumcision. Circumcision was performed applying one of the following surgical techniques: sutureless prepuceplasty (SP), preputial plasty technique (PP), and conventional circumcision (CC). Demographics and base-line clinical characteristics were collected, and assessment of the level of preoperative anxiety was performed. Subsequently, a statistical model was designed in order to examine predictive factors of postoperative pain and postoperative anxiety. Assessment of postoperative pain was performed using the Faces Pain Scale (FPS). The Post Hospitalization Behavior Questionnaire study was used to assess negative behavioral manifestations. Results: A total of 301 children with a mean age of $7.56{\pm}2.61$ years were included in the study. Predictive factors of postoperative pain measured with the FPS included a) the type of surgical technique, b) the absence of siblings, and c) the presence of postoperative complications. Predictive factors of postoperative anxiety included a) the type of surgical technique, b) the level of education of mothers, c) the presence of preoperative anxiety, and d) a history of previous surgery. Conclusions: Although our study was not without its limitations, it expands current knowledge by adding new predictive factors of postoperative pain and postoperative anxiety. Clearly, further randomized controlled studies are needed to confirm its results.

• Journal of Chest Surgery
• /
• v.19 no.3
• /
• pp.443-448
• /
• 1986

Aortic dissection is a serious disease that mortality does not approach to zero despite of medical and surgical improvement. Recently two cases of aortic dissection were treated with good results by the two other methods. Case 1 [57-Y-0-Male]; Chief complaint was chest pain radiating to the back. Preoperatively he was controlled by Minipress, dichlotride, & sodium nitroprusside. Aortography showed DeBakey Type III aortic dissection extending from just below the Lt. subclavian artery to the proximal portion of the origin of the renal artery. Through the midline long incision Flow reversal & Thrombo-exclusion method was used, and bypass course was proximal anastomosis at the ascending aorta - through the Rt. thoracic cavity - midportion of the diaphragm - posterior to the liver, stomach, & pancreas - distal anastomosis at the abdominal aorta proximal to its bifurcation. Bypass graft was preclotted 20 mm Dacron Woven Graft, and the aortic arch between the Lt. subclavian artery & Lt. common carotid artery was divided and meticulously sutured. Control aortogram which was done at 4th postoperative month revealed obstruction of the false lumen by thrombosis, and complications were not noticed. Case 2 [53-Y-0-Male]; Chief complaint was chest pain radiating to the abdomen. DeBakey Type III aortic dissection which was similar to the case 1 was detected by the aortography, and involvement of the Lt. subclavian & common carotid arteries was suspicious. Through the Lt. posterolateral thoracotomy the Ringed Intraluminal Sutureless Graft, No. 22 mm, was inserted from just below the Lt. common carotid artery to the midportion of the descending thoracic aorta under total circulation arrest using a F-F bypass, and the Lt. subclavian artery was ligated. Postoperatively hospital course was uneventful with antihypertensive drugs, and any specific complications were not noticed.

• Journal of Chest Surgery
• /
• v.40 no.6 s.275
• /
• pp.448-450
• /
• 2007

The mortality of left ventricular free wall rupture after acute myocardial infarction is high; however, subactue myocardial rupture can be diagnosed by echocardiogram and the use of the intraaortic balloon pump reduces the incidence of re-rupture. Bleeding from subacute myocardial rupture can be managed by employing fibrin glue and several patches. We report here on a case of successfully managed case of subactue left ventricular free wall rupture after acute myocardial infarction with using the sutureless technique and fibrin glue.