• Journal of Chest Surgery
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• v.26 no.5
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• pp.390-394
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• 1993

This study elvaluated clinically the surgical results of the thirty-eight patients who had exploratory thoracotomy for spontaneous pneumothorax between Jan. 1989 and Nov. 1992. Thirty three, or 86.8%, of the patients were male. The most frequent age of the spontaneous pneumothorax requiring thoracotomy was between fifteen years and twenty years. Sudden onset dyspnea and chest pain, which developed in thirty-five patients[89.5%], were the major chief complaints. Bleb and Bulla located in the both upper lobes were the most frequent causes of spontaneous pneumothorax for exploratory thoracotomy. There was no operative death. Postoperative morbidity included three cases of residual air space in the apical pleural space, tow cases of atrial fibrillation, and one each case of reoperation for bleeding, mediasitinitis, and sternal osteomyelitis. All postoperative complications were treated without any serious problems. This study suggests that early exploratory thoracotmy is desirable for patients with prolonged air-leak, massive air-leak, or multiple blebs and giant bullae on the computed tomography of the chest.

• Journal of Chest Surgery
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• v.24 no.3
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• pp.261-264
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• 1991

The result of thoracotomy for recurrent and persistent pneumothorax is usually excellent. However the patients undergone thoracotomy suffer from postoperative chest pain and require long postoperative recovery period. Also the operative incision scar gives the patients cosmetic problems. Subpleural blebs are usually causes of pneumothorax. They can be reached through the thoracoscope without thoracotomy and can be ablated by electrical cautery through it. Six patients with recurrent and persistent pneumothorax were managed thoracoscopic-ally. Five patients were successful and one case was failed. The failed case was explored 21 days after thoracoscopy. Follow-up period was from one to eight months. Although the follow-up period was short, thoracoscopic management of recurrent and persistent pneumothorax is thought to be good for preventing thoracotomy.

• The Korean Journal of Pain
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• v.21 no.2
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• pp.106-111
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• 2008

Background: Chronic pain after thoracotomy has been recently reproduced in a rat model that allows investigating the effect of potentially beneficial drugs that might reduce the incidence of allodynia or alleviate pain. Local anesthetics produce antinociception in normal animals and alleviate mechanical allodynia in animals with nerve injury although their mechanisms of action may differ in these situations. Our purpose of this study was to test whether the preoperative intercostal nerve block of bupivacaine could prevent the development of allodynia in a rat model of chronic postthoracotomy pain. Methods: All male Sprague-Dawley rats were anesthetized and the right 4th and 5th ribs were exposed surgically. The pleura were opened between the ribs to which a retractor was placed and was opened 10 mm in width. Retraction was maintained for one hour. Total 1 mg of 0.5% bupivacaine was injected at the intercostal nerves before (n = 17) or after (n = 16) surgery. A control group (n = 25) that underwent rib retraction did not receive any drug. Rats were tested for mechanical allodynia using calibrated von Frey filaments applied around the incision site during the three weeks following surgery. Results: The incidence of development of mechanical allodynia in the group that received intercostal injection with bupivacaine before surgery was significantly lower than that in the control group (P < 0.05). Conclusions: Preoperative intercostal nerves block around the surgical incision before thoracotomy may decrease the incidence of postthoracotomy pain syndrome.

• Journal of Chest Surgery
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• v.3 no.1
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• pp.17-20
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• 1970

Six cases of broncho-pleural fistula due to complicated liver abscess were experienced at the department of chest surgery, Seoul National University Hospital from October 1967 to March 1970. Amebic liver abscess was the primary cause in the 5 cases and the remaining one case was due to pyogenic liver abscess. Involved lung was right side in all case. The clinical manifestation was fever,chill,cough, sputum, dyspnea, chest pain, hemoptysis and shoulder pain. The methods of the treatment employed were closed thoracotomy [1], thoracotomy & drainage [2],decortication [1],and right lower lobectomy[3]. The average duration of the post-operative course was 19.6 days. There was no operative mortality.

• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.957-959
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• 2006

Muscle sparing thoracotomy is known as alternative of posterolateral thoracotomy because of less postoperative pain, preservation of muscle power and better cosmetic outcome. Curved axillary thoracotomy(CAT) is a type of muscle sparing thoracotomy. Between July 2003 and August 2004, 5 patients diagnosed as pure patent ductus arteriosus(PDA) treated by CAT and we reviewed results retrospectively by clinical record. The operative procedures were ligation of ductus in 4 cases and division of ductus in 1 case. There were no postoperative complication. Curved axillary thoracotomy is considerable alternative for surgical treatment of PDA with merits of muscle sparing effect and cosmetic benefit.

• Journal of Chest Surgery
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• v.33 no.9
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• pp.738-743
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• 2000

Background: Video-assisted thoracic surgery(VATS) is being used as a therapeutic modality in many diseases in which thoracotomy has been used. We studied that the VATS can substitute the thoracotomy in benign esophageal disease. Material and Method: Group I (n=18) underwent video-assisted thoracic surgery, and group II(n=19) thoracotomy. Group I includes 14 leiomyomas and 4 achalasias. Group II includes 16 leiomyomas and 3 achalasias. Operative technique is enucleation in the leiomyoma and modified Heller's myotomy in the achalasia. Analyzing factors of operation-efficacy are anesthetic time, operation time, hospital stay, chest tube drainage amount and chest tube removal day. The degree of the postoperative pain is assessed by the frequency of opioid analgesics injection. Result: There was no death in both groups. There were 5 complications in the group I and 2 in the group II. Prolonged pleural effusion and restenosis of achalasia occurred to 1 patient in each group. In the group I, there were 1 temporaty vocal cord palsy and 2 mucosal tear leading to thoracotomy. There were no differences in anesthesia time, operation time, hospital stay, total chest tube drainage amount, chest tube removal day and frequency of opioid analgesics injection. The amount of the chest tube drainage at POD 1 day was significantly lower in group I(155.6$\pm$77.8cc) than in group II(572.8$\pm$280.1cc)(p<0.05). Conclusion: The results of our data showed that video-assisted thoracic surgery for benign esophageal disease is as effective as thoracotomy and in addition, cosmetic effect is much better. We concluded VATS may be a substitute for thoracotomy in benign esophageal disease.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.822-834
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• 1985

Reexpansion of the lung is the most desirable method of filling the pleural space whether it`s contents may be, and closed thoracotomy connected to a water-seal drainage remains the basic therapeutic modality in the treatment of the problems of the pleural space. We usually used rubber mushroom tubes, size No. from 16 to 34 Fr., and performed closed thoracotomy after preliminary thoracentesis to determine the exact depending position. Author reviewed 576 cases of closed thoracotomy which were performed in the Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, since Jan., 1980 to June, 1984. The results were as follows: 1. The age distribution was 10 days to 76 years old and mean age of the patients was 36.6 year, and the most prevalent age group was twenties, and sex predisposition was male dominant, 86.9%. 2. The most common etiologic disease group was pneumothorax and the most common etiologic disease was traumatic hemothorax. 3. Sites of tubing were predominantly at posterior axillary line, 7th intercostal space and midclavicular line, 2nd intercostal space even though frequent presence of free pleural space. The two sides, right and left difference of occurrence rate was more frequent at right side, 51.2%. 4. Usually the durations of tubing was less than 10 days, 52.6%, and the number of tubes used to the same patient concomitantly was one, 73.9%, and the time of tubing to the same patient was 1st, 83.6%. 5. The common symptom and sign were dyspnea, 50.0%, chest pain, 30.7%, cough, 10.7%, fever, 6.5%. Especially, fever and cough was the most common symptom and sign in pyogenic empyema, 59.3%. 6. The common etiologic lesions of pneumothorax were blebs and bullae, 73.3%, and of pyogenic empyema was pneumonia, 69.0%. 7. The complication rate of closed thoracotomy was 26.0%. Among these complications, infection was 44.7%, and intercostal neuralgia was 25.3%. 8. 70.9% of all patients recovered with only closed thoracotomy and the rest of patient needed additional some necessary managements such as open thoracotomy [Blebectomy, Resection, Pleurodesis, Decortication, Bleeding control], open drainage, thoracoplasty and so on to have successful results.

• Journal of Chest Surgery
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• v.52 no.3
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• pp.125-130
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• 2019

Background: To compare the outcomes of video-assisted thoracoscopic surgery (VATS) in comparison to open thoracic surgery in pediatric patients suffering from empyema. Methods: A prospective study was carried out in 80 patients referred to the Department of Pediatric Surgery between 2015 and 2018. The patients were randomly divided into thoracotomy and VATS groups (groups I and II, respectively). Forty patients were in the thoracotomy group (16 males [40%], 24 females [60%]; average age, $5.77{\pm}4.08years$) and 40 patients were in the VATS group (18 males [45%], 22 females [55%]; average age, $6.27{\pm}3.67years$). There were no significant differences in age (p=0.61) or sex (p=0.26). Routine preliminary workups for all patients were ordered, and the patients were followed up for 90 days at regular intervals. Results: The average length of hospital stay ($16.28{\pm}7.83days$ vs. $15.83{\pm}9.44days$, p=0.04) and the duration of treatment needed for pain relief (10 days vs. 5 days, p=0.004) were longer in the thoracotomy group than in the VATS group. Thoracotomy patients had surgical wound infections in 27.3% of cases, whereas no cases of infection were reported in the VATS group (p=0.04). Conclusion: Our results indicate that VATS was not only less invasive than thoracotomy, but also showed promising results, such as an earlier discharge from the hospital and fewer postoperative complications.

• Journal of Chest Surgery
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• v.24 no.2
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• pp.182-189
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• 1991

Fourteen patients underwent surgical resection of bullae between February, 1987 and June, 1990 via median sternotomy. Twelve patients had spontaneous pneumothorax with previous history of pneumothorax on the contralateral side or visible bullae on chest X-ray films. Two patients had bullous emphysema. The duration of operation and admission, frequency and amount of analgesic administered for pain control, pulmonary function test [FEV1, FVC, MVV] and the amount of bleedings were compared with six cases of staged unilateral thoracotomy. The results were as follows: 1. All patients were male. 2. Mean follow up period was 13.5 month and no recurrence of pneumothorax are noted after the operation. 3. Median sternotomy showed shortened admission days than thoracotomy. [12.4$\pm$2.7, 15.6$\pm$3.1 days] 4. Significantly shortened anesthetic time in median sternotomy than thoracotomy [121$\pm$21, 184$\pm$33 minutes] 5. Median sternotomy required less injection of analgesics than thoracotomy. [6.5$\pm$2.7, 13.5$\pm$3.1 ampules] 6. Bleeding amount and PFT showed no differences. 7. Complications were prolonged air leakage for more than 7 days [2 patients], transient elevation of SGOT and SGPT[2 patients], and wound infection[1 patient]

• Journal of Chest Surgery
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• v.24 no.8
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• pp.757-764
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• 1991

We have observed 360 cases of spontaneous pneumothorax from January 1980 to May 1991 at the department of Thoracic and Cardiovascular Surgery, Chosun University Hospital. Males occupied 266 cases[73.9%] and females 94 cases[26.1%], and its ratio was 2.8: l. The age of patients ranged from neonate[5 days] to 84 years old. The site of pneumothorax was right in 50.3%, left in 43.3% and bilateral in 6.4%a. The clinical symptoms were frequently dyspnea, chest pain and coughing. The associated pulmonary lesions were shown pulmonary tuberculosis in 199 cases[55.3%], bullae in 54, pulmonary emphysema in 31, COPD in 17, pneumonia in 6, lung cancer in 5, paragonimiasis in 5, catamenial pneumothorax in 3 and unknown underlying pathology in 39 cases. The results of surgical management of spontaneous pneumothorax are followings: 288 out of 360 cases[80.0%] were cured by closed thoracotomy, 53 cases[14.8%] were cured by open thoracotomy. Open thoracotomy was the most effective procedure in persistent air leakage, recurrent pneumothorax, visible bleb or bullae on the chest X-ray, associated lesion, bilateral simultaneous pneumothorax, parenchymal incomplete lung expansion and bleeding after closed thoracotomy. The incidence of complication was developed in 10. ado and recurrent rate was seen in 10.6%. There was no operative death.