• Journal of Chest Surgery
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• v.31 no.11
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• pp.1081-1084
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• 1998

Background: Esophageal surgery in esophageal cancer has low curative resection rate and its resut has not improved even after the extended lymphnode dissection. To evaluate the effectiveness of cervical lymph node dissection, we compare the node of cervical lymph node metastasis in patients esophageal cancer. Materials and methods: We studied a series of 32 patients who underwent operation for thoracic esophageal carcinoma at our institution. The 25 patient who underwent curative surgery were divided into two groups. Both groups A and B underwent transthoracic esophagectomies with mediastinal and abdominal lymphadenectomies only, but group B also underwent bilateral lower neck node dissection. Results: The rate of operative complications did not differ significantly between two groups. No operative and hospital mortalities were noted in either group. However, the mean anesthetic time was significantly longer in group B(mean: 90 minutes). Neck node metastasis was revealed in 27% of group B. Conclusions: Therfore, neck node dissection is meaningful for surgical treatment of the thoracic esophageal carcinoma. The longterm survival rate should be compared later.

• Journal of Chest Surgery
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• v.41 no.6
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• pp.803-806
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• 2008

The Nuss procedure has good cosmetic effects, but it could be cause of bleeding and organ injury during dissection of the anterior mediastinum. We have made an effort to overcome the defects of the traditional method through the anterior mediastinum, thus we developed a transilluminated introducer that made it safer and simpler to operate within a 1cm incision only. A total of 67 patients underwent the Nuss procedure using the transilluminated introducer. Thirty-six patients underwent the procedure with the transilluminated introducer only (age<4 years). Thirty-one patients had an additional thoracoscopy ($age{\geq}14\;years$). There were no major complications, such as massive bleeding or organ injury in the thoracic cavity during or after the Nuss procedure. Our findings demonstrated that the anterior mediastium could be dissected simply and safely by the use of a transilluminated introducer during the Nuss procedure without fatal major complications, such as bleeding and organ injury.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.482-485
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• 2006

Video-assisted thoracoscopic surgery has gained a broad acceptance for various thoracic lesions because it is the minimally invasive surgery with little tissue trauma, less pain, improved cosmetic results and short recovery time. However, there are some limitations for this method, such as restricted visual sensory information to a two-dimensional image and limited maneuverability of the tips of the instruments. To overcome these limitations, advanced technology has been introduced and the da $Vinci^{TM}$ Surgical System (Intuitive Surgical Inc, Mountain View, CA, USA) became available in 2001. In Korea, the da $Vinci^{TM}$ Surgical System was introduced in Severance hospital (Yonsei University College of Medicine) in May 2005, and approved by KFDA in July 2005. Herein, we report the first experience of robot-assisted thoracic surgery with the da $Vinci^{TM}$ Surgical System in extirpation of a large teratoma in anterior mediastinum.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.11 no.1
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• pp.361-367
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• 2010

The study was conducted on a total of 146 patients who cancelled planned surgeries at a University Hospital located in Daejeon for one year from Jan., 1 to Dec., 31, 2007 with the purpose of minimizing cancellation ratio of planned surgeries and thereby improving hospital management reasonably and raising service satisfaction. Participants in this study consisted of 56.8% of male patients and 43.2% of female patients, with a higher proportion of female than male patients. The causes of cancelled planned surgeries were classified into controllable and uncontrollable cases. 60.0% of the cases that cancelled planned surgeries were classified into controllable cases based on the classification of surgical risk. From these findings, the study proposes that researchers and hospital managers establish policy directions to reduce and improve surgery cancellation ratio.

• Progress in Medical Physics
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• v.15 no.4
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• pp.197-201
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• 2004

Stereotactic brain biopsy using stereotactic head frame such as CRW (Radionics, USA) has demonstrated a precise lesion localizing accuracy. In this study, we developed the target point calculation program for brain lesion biopsy using CRW stereotactic head frame and designed a phantom for verify the new developed program. The phantom was designed to have capability to simulate clinical stereotactic brain biopsy. The phantom has 10 vertical rods whose diameters are 6mm and tip of each rods are 2mm. Each rod has different length, 150 mm x 4 ea, 130 mm x 4 ea, 110 mm x 2 ea. CT images were acquired with Simens CT scanner as continuous transverse slice, 1 mm thickness in a 25 cm field of view and stored in a dicom file as a 256 x 256 matrix. As a result, the developed new target localization program will be useful for planning and training in complicated 3 dimensional stereotactic brain biopsy.

• Journal of Convergence for Information Technology
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• v.11 no.2
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• pp.47-56
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• 2021

The purpose of this research was to develop an augmented reality-based surgical nursing practice education application. The research proceeded in ADDIE order of analysis, design, development, implementation, and evaluation stages. In the analysis phase, we analyzed the surgical nursing learning needs of the expert group and nursing student group. As a result of the analysis, the demand for surgical instruments was generally high. We selected 51 surgical instruments of the 7 categories most frequently used in the operating room based on the needs, and produced them as AR Book. The augmented reality application was created based on the Unity 3D engine, and the application was built with Android OS so that the target person could use it. Expert assessment of application for augmented reality-based surgical nursing practice education application showed 73.4±4.3 out of 80. This study is significant in the part that first developed a new method of learning tools for surgical instruments. We determined that an augmented reality-based application has reality, portability, accessibility and simplicity.

• The Journal of the Korean bone and joint tumor society
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• v.18 no.2
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• pp.59-65
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• 2012

Purpose: Multidisciplinary approaches of surgical resection and chemotherapy have been widely used for the treatment of non-metastatic osteosarcomas. We aimed to assess the effect of neoadjuvant chemotherapy for metastasis and disease-specific survival. Materials and Methods: Authors retrospectively reviewed 225 young (<30 years old) and non-metastatic osteosarcoma patients who underwent surgical resection and postoperative chemotherapy between February 1984 and July 2010. Mean age was 14.4 years old (ranged: 4-29 years old) and average follow-up period was 9.1 years (2-28 years). The patients were divided into two groups according to the application of preoperative chemotherapy. Both groups were compared with clinical characteristics, metastasis-free survival and disease-specific survival. Results: All of 225 patients, 32 patients were treated with postoperative chemotherapy and 193 patients were performed preoperative and postoperative chemotherapy. Postoperative chemotherapy group showed significantly high rate of amputation (p<0.001). Metastasis was occurred in 101 patients. Postoperative chemotherapy group indicated significant higher rate of metastasis (69% vs 41%, p=0.004) and early development of metastasis (mean: 11.5 vs 20.3 months, p=0.045) than pre-and postoperative chemotherapy group. Fifty-seven patients were died of osteosarcoma. Postoperative chemotherapy group revealed significant lower rate of 5-year disease-specific survival than pre-and postoperative chemotherapy group (51% vs 84%, p=0.001). Adult (>15 years) and large sized tumor (>8 cm) were meaningful risk factors of metastasis and disease-specific survival. Although, local recurrences were occurred in 13 patients, there was no significant difference. Conclusion: Neoadjuvant chemotherapy offers better disease-specific survival and metastasis-free survival.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.349-355
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• 2004

Non-small cell lung cancer (NSCLC) with invasion of mediastinal structures is classified as stage IIIB, and has been considered surgically unresectable However, in a selected group of these patients, better results after surgical resection compared to non-surgical group have been reported. The aim of this study is to evaluate the role of surgical resection in treatment of mediastinal T4 NSCLC. Material and Method: Among 1067 patients who underwent surgical intervention for non-small cell lung cancer from Aug 1987 to Dec 2001 in Korea cancer center hospital, 82 patients had an invasion of T4 mediastinal structures (7.7%). Resection was possible in 63patients (63/82 resectability 76.8%). Their medical records in Data Base were reviewed, and they were followed up completely until Jun 2002. Surgical results and prognostic factors of NSCLC invading mediastinal structures were evaluated retrospectively. Result Lung cancer was resected completely in 52 patients (63.4%, 52/82). Lung resection was lobectomy (or more) in 14, pneumonectomy in 49. The mediastinal structures invaded by primary tumor were great vessel (61.9%), heart (19%), vagus nerve (9.5%), esophagus (7.9%), and vertebral body (7.9%). Nodal status was N0 in 11, N1 in 24, and N2 in 28 (44.4%). Neoadjuvant therapy was done in 6 (9.5%, 5 chemotherapy, 1 radiotherapy), and adjuvant therapy was added in 44 (69.8%, 15 chemotherapy, 29 radiotherapy) in resection group (n=63). Complication was occurred in 23 (31.7%), and operative mortality was 9.5% in resection group. Median and 5 year overall survival including operative mortality was 18.1 months and 21.7% in resection group (n=63), 6.2months and 0% in exploration only group (n=19, p=.001), 39 months and 32.9% in N2 (-) resection group (n=35), and 8.8 months and 8.6% in N2 (+) resection group (n=28, p=.007). The difference of overall survival by mediastinal structure was not significant. Conclusion: The operative risk of NSCLC invading mediastinal structures was high but acceptable, and long-term result of resection was favorable in selected group. Aggressive resection is recommended in well selected pateints with good performace and especially N2 (-) NSCLC with mediastinal invasion.

• Journal of Gastric Cancer
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• v.5 no.2
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• pp.95-100
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• 2005

Purpose: Critical pathways (CP), also known as clinical pathways, are management plans that display goals for patients and have led to improved outcomes for many disease entities. This study was aimed at developing a critical pathway for the surgical treatment of gastric cancer patients and evaluating its usefulness. Materials and Methods: A CP was developed and implemented by a team of surgeons, nurses, nutritionists, and administrative officials. Among the 117 patients who received curative gastrectomies for gastric cancer at Kangnam St. Mary's Hospital, The Catholic University of Korea, between October 2003 and August 2004, 26 patients were treated according to the CP. We evaluated its usefulness by comparing the clinical characterisctics, postoperative progress, hospital stays, and costs between the CP and the non-CP groups. Patient satisfaction was also surveyed with questionnaires. Results: Of the initial 26 patients in the CP group, two were excluded from the final evaluation; one patient had a duodenal stump leakage, and the other had a gastric stasis postoperatively. In 8 patients, protocol violation occurred; six patients refused to be discharged on the $7^{th}$ postoperative day, one patient who had an gastric staisis postoperatively stayed for 2 additional days, and one patient who needed ICU care stayed for 4 additional days. The drop-out rate was $7.7\%$ (2/26), and the variance rate was $30.8\%$ (8/26). The mean hospital stay was 11.3 days ($10\~15$ days) for the CP group compared with 17.5 days ($9\∼68$ days) for the non-CP group, resulting in a difference of about 6 days (P<0.05). The mean hospital stays after surgery were 10.3 days ($7\∼68$ days) and 8.3 days ($7\∼12$ days) for the non-CP and the CP groups, respectively, but the difference was statistically not significant (P>0.05). The mean charge during the hospital stay was higher in the non-CP group ( $\\$ 6,292,200) than in the CP group ( $\\$ 4,863,685). The charge per hospital day was higher in the CP group ( $\\$ 430,414) than in the non-CP group ( $\\$ 359,554). Patient satisfaction was higher in the CP group than in the non-CP group. Conclusion: By developing and applying a critical pathway in the surgical treatment of stomach cancer patients, we could reduce the length of hospital stay as well as the cost. A multi-centered prospective study to establish a standard treatment pathway and to demonstrate its effectiveness is needed in the future.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.7 no.1
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• pp.8-15
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• 2004

Purpose: This study was conducted to identify potential dangers involved in procedure and evaluate complications of percutaneous endoscopic gastrostomy (PEG) comparing to surgical gastrostomy (SG). Methods: A retrospective study of 66 children with feeding gastrostomy between 1994 and 2002 was done. Results: Of 66 children, 23 (mean age 29 months) had PEG and 43 (mean age 49 months) had SG. 31 cases of SG group had fundoplication for gastroesophageal reflux disease. PEG groups were followed up with an average 13 months and SG groups with 21 months. Major complications occurred in 33% of PEG group (8/23) and 55% of SG group (24/43). Major complications were significantly lower in PEG group than SG group and minor complications, too (p<0.05). Of major complications, aspiration pneumonia was the most common but paralytic ileus was significantly higher in SG group than PEG group. 8 patients died of underlying disease but not related to gastrostomy. Removals of stomata were done in 5 of PEG group and 3 of SG group. GER recurred in 25% of SG group with fundoplication and newly developed in 17% of SG group. GER persisted in 17% and newly developed in 5% of PEG group. Conclusion: The gastrostomy was a significant procedure with the potential to produce complications. PEG is recommended as an initial procedure in children requiring a feeding gastrostomy but should be considered a major undertaking.