• Journal of Chest Surgery
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• v.35 no.5
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• pp.392-396
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• 2002

Background: Video-thoracoscopy is known to be an useful method to provide accurate pre-resectional staging in patients with lung cancer in addition to the conventional radiologic studies and mediastinoscopy, for the pleural cavity is inspected directly and biopsy specimens call be obtained. This study is undertaken to evaluate how video-thoracoscopy can be used in deciding pre-resectional stage Material and Method: Video-thoracoscopy was performed in patients with lung cancer who were scheduled for surgical resection based on the radiologic staging and mediastinoscopic biopsy. 37 patients were included in this study. Pre-thoracoscopically 18 cases were in TNM stage 1, 7 in stage 2, and 12 in stage 3. Result: In 15 of 37 cases, video-thoracoscopy could not be performed effectively due to heavy adhesions in the pleural cavity, diaphragmatic and chest wall invasion of tumor and bulky tumor mass es. Mediastinal lymph nodes were positive postresectionally in 6 of these 15 cases. In 22 cases, video-thoracoscopy was performed as usual. Positive mediastinal lymph nodes were identified in 2 cases and exploratory thoracotomy was prevented. Surgical resection were carried out in remaining 20 cases and 5 cases among them had positive mediastinal lymph nodes. Conclusion: We believe that it is difficult to perform pre-thoracotorny video-thoracoscopy for all lung cancer patients for there were many cases that thoracoscory could not be undertaken doe to heavy adhesions in the pleural cavity, tumor involvement of the chest wall and/or diaphragm and bulky tumor mass. However we think it is helpful in preventing unnecessary exploratory thoracotomy for some patients with lung cancer whom pre-thoracotomy video-thoracoscopy was carried out.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.732-738
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• 1999

Background: Video-assisted thoracoscopic surgery has become a standard therapy for several diseases such as pneumothorax, hyperhidrosis, mediastinal mass, and so on. These methods usually required single-lung ventilation with double-lumen endobronchial tube to collapse the lung under general anesthesia. However, risks of general anesthesia itself and single-lung ventilation must be considered in high-risk patients. Material and method: Between December 1997 and July 1998, eight high-risk patients (6: empyema, 1: intractable pleural effusion, 1: idiopathic pulmonary fibrosis) with underlying pulmonary disease and poor general condition were treated by video-assisted thoracoscopic surgerys under epidural anesthesia and spontaneous breathing. Result: Video-assisted thoracoscopic surgerys were successfully per formed in 7 patients. Conversion to general anesthesia was required in 1 patient because of decrease in spontaneous breathing. But, conversion to open decortication was not required. In two patients with chronic empyema, one patient required thoracoplasty as a second procedure and one patient required re-video-assisted thoracoscopic procedure due to a recurrence. The mean operative time was 31.8$\pm$15.2 minutes. No significant postoperative respiratory com plication was encountered. Conclusion: Video-assisted thoracoscopic surgerys can be per formed safely under epidural anesthesia for the treatment of empyema and diagnosis of pulmonary abnormalities in high-risk patients.

• Journal of Chest Surgery
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• v.36 no.9
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• pp.678-682
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• 2003

Video-assisted thoracoscopic surgery is good indication of secondary spontaneous pneumothorax. This method usually required general anesthesia and single-lung ventilation with collapse of other lung. But, risks of general anesthesia and single-lung ventilation must be considered in high-risk patients. Material and Method: Between September f999 and August 2001, 15 high-risk patients were treated by video-assisted thoracoscopic surgery under epidural anesthesia. Result: Video assisted thoracoscopic surgery was successfully performed in 15 patients. Duration of postoperative air-leakage was 4.3days, Significance of complication was none, No recurrence of pneumothorax was encountered. Conclusion: Video-assisted thoracoscopic surgery can be performed safely under epidural anesthesia for treatment of secondary spontaneous pneumothorax in high-risk patients.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.937-942
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• 2003

Morbidity, the use of analgesics, the amount of postoperative drainage and the postoperative hospital stay were reduced in VATS for pneumothorax. However, some authors preferred minithoracotomy to VATS because the rate of recurrence after VATS were between 5% and 10%. Therefore, we present a modified thoracoscopic bullectomy (MTB) which we believe has the advantages of conventional VATS and minithoracotomy. Material and Method: Sixty-six patients who received the operation from January 2002 to December 2002 were divided into 3 groups. Twenty-six patients were treated by axillary minithoracotomy and thirteen by conventional VATS and 18 by modified thoracoscopic bullectomy, The mean age was 21.9 years (range, 16∼35 years) for minithoracotomy group, 20.6 years (range, 17∼28 years) for conventional VATS group and 22.6 years (range, 16∼39 years) for MTB group. The mean follow-ups were 11.4 months for minithoracotomy group, 9.5 months for conventional VATS group and 4.7 months for MTB group. Result: The mean duration of operation was 55.79$\pm$23.35 minutes in MTB and 44.23$\pm$19.24 minutes in conventional VATS (p=0.333). The number of staplers being used was 1.63 $\pm$0.76 in MTB, 1.41$\pm$0.64 in minithoracotomy (p=0.663), and 2.92$\pm$1.19 in conventional VATS (p<0.001). The duration of indwelling chest tube was 1.63$\pm$0.76 day in MTB, 4.07$\pm$ 1.41 day in minithoracotomy (p<0.001) and 4.46$\pm$2.33day in conventional VATS (p<0.001). Hospital length of stay was 3.26$\pm$0.81 day in MTB, 6.04$\pm$2.21 day in minithoracotomy (p<0.001) and 6.69$\pm$3.33 day in conventional VATS (p<0.001). The number of postoperative complication and recurrence were 2 in minithoracotomy (7.4%), 5 in conventional VATS (38.5%) and 1 in MTB (5.6%). Conclusion: Modified thoracoscopic bullectomy is an effective procedure in the treatment of spontaneous pneumothorax.

• Journal of Chest Surgery
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• v.38 no.9 s.254
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• pp.627-632
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• 2005

Background: The video-assisted thoracic surgery (VATS) with 2 mm thoracoscopy in primary spontaneous pneumothorax (PSP) was known to be unreliable in its accuracy and recurrence rate. We compared 10 mm VATS with 2 mm VATS in the results of operation. Material and Method: From Sept. 1998 to Dec. 2002, 176 cases (10 mm VATS; 73 cases, 2 mm VATS; 103 cases) of PSP were treated by VATS blob resection at Korea University Ansan Hospital. 10 mm thoracoscope, 5 mm port, and 5 mm instruments were used in 10 mm VATS group, and 2 mm thoracoscope, 2 mm ports and 2 mm instruments used in 2 mn VATS group. In the two groups, staples were inserted through 11.5 mm port for chest tube. Result: The mean follow-up duration was 20,8$\pm$16.1 months in 10 mm VATS group, and 13.9 $\pm$8.2 months in 2 mm VATS. The most common indication of operation was a recurrent pneumothorax ($34\%$) in 10 mm VATS and patient's desire ($40\%$) in 2 mm VATS, respectively. The operation time, number of staples used in operation, postoperative chest tube keeping days, postoperative total amount of drainage, and postoperative hospitalization days were statistically lower in 2 mm VATS. Other significant variables affecting the operation time in linear regression analysis were the number of staples that used in operation, the presence of pleural adhesion, and type of pleurodesis and thoracoscope used in operation. However, $R^2$ values were lower than 0.1. The postoperative recurrence rate was $2.7\%$ in 10 mm VATS and $2.9\%$ in 2 mm VATS. It was not significant statistically. Recurrent cases developed within 1 year in both groups but the difference was statistically insignificant. Conclusion: Although there were differences in follow-up duration between two groups, the operation time, number of staples that used in operation, postoperative chest tube keeping days, postoperative total amount of drainage, and postoperative hospitalization days were statistically lower in 2 mm VATS. And in 2 mm VATS, there were no technical difficulties during operation and no differences in recurrence rate from 10 mm VATS. As a result, we suggest that 2 mm VATS can be used in the treatment of PSP.

• Journal of Chest Surgery
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• v.37 no.8
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• pp.715-717
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• 2004

A 59-year old woman visited us for incidentally detected posterior mediastinal mass. Preoperative esophagography, esophagoscopy, esophageal ultrasound and computed tomography showed a esophageal submucosal tumor. With the diagonsis of esophageal leiomyoma, the patient underwent right side video-assisted thoracoscopic surgery (VATS): The mediastinal pleura and the esophageal muscle layers were longitudinally opened and the tumor was enucleated. Esophagography performed at 6th postoperative day revealed no esophageal mucosal bulging or leakage. The patient was discharged reveiving a soft diet on the 7th postoperative day.

• Journal of Chest Surgery
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• v.33 no.11
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• pp.898-903
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• 2000

배경 및 목적: 최근 비디오 흉강경술은 최소 침습적인 수술 방법으로서 자연 기흉의 일반적 치료법으로 인정되고 있으나 비교적 높은 재발율과 비용-효용 관계에 대해서는 논란이 있다. 비디오 흉강경을 이용한 기포 절제술 후의 재발율은 평균 5-10%정도로 보고되고 있으며 이는 개흉술에 비해 상당히 높은 것이다. 또한 국내 의료 실정에서의 개흉술과 비디오 흉강경술의 비용효용에 대한 비교 통계는 없는 상황이다. 대상 및 방법: 1997년 1월부터 1999년 7월까지 일차성 자연기흉으로 성균관 의대 강북삼성병원 흉부외과에서 수술을 시행한 173예를 대상으로 후향적 조사하였다. 비디오 흉강경술로 시행한 104예와 개흉술로 시행한 69예를 양군으로 나누어 성별 및 연령, 발병부위, 수술의 적응증, 수술시간, 술 후 흉관 삽입기간 및 재원 일수, 술후 합병증, 재발율, 수술 경비 및 총치료경비 등을 비교하였다. 결과: 양군의 성별, 연령, 발병부위 등에는 차이가 없었다. 수술 시간은 흉강경군이 73.1$\pm$29.5분, 개흉군이 141$\pm$52분이었다.(p<0.05). 술 후 평균 흉관의 거치기간 및 재원일수는 흉강경군이 각각 3.93일 및 7.5일, 개흉군이 7.0일 및 13.4일이었다.(P<0.05, P<0.05). 술 후 재발한 경우가 비디오 흉강경군에서 6예(5.6%), 개흉군에서 1예(1.4%) 있었다(P<0.05). 본원에서 시행한 비디오 흉강경술과 개흉술의 비교에서 수술로 발생하는 비용은 비디오 흉강경군이 유의하게 높았으나 (1,202,192$\pm$178,992원, 1,005,669$\pm$311,531원; P<0.05) 총 치료비의 비교에서는 유의한 차이가 없었다.(1,946,110$\pm$487,440원, 1,793,912$\pm$308,079원; P=0.18). 결론: 비용 효용관계 및 재발율은 병원마다의 수술 수기 및 퇴원 정책등에 따라서 다소간의 차이가 있을 수 있으나 본원의 조사 결과에서는 비디오 흉강경술이 개흉술에 비해 비용-효과가 있다고 볼 수 없으며 재발율도 높았다.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1111-1116
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• 1997

In a period from Sep 1994 to Sep 1996, 38 patients were treated for spontaneous pneumothorax by video-assisted thoracic surgery(VATS). 31 male and 7 female patients with ages between 17 and 79(mean 30.0 years). No death occured. The postoperative complication rate of VATS was 7.9%(3/38). We noted no recurrence of pneumothorax, 3 wound dehiscence, 3 persistent air leak(>7days) in the patients. We compared theses results with thoracoscopic surgery of spontaneous pneumothorax in 38 cases(Group A), with cases of 21 patients(Group B) performed by the thoracotomy in the same period. There have been no recurrence in groud A, and one recurrence in group B at a median follow-up of 14.37$\pm$7.48 months and 16.81 $\pm$7.12 months, respectively. There was no significant difference in the duration of operation time including induction time between VATS and thoracotomy, but postoperative hospital stay and chest tube drainage periods were all less for these undergone VATS. Postoperative complication was less in group A(3/38=7.9%, 3 cases with persistent air leak >7days, all developed wound dehiscence, too), than in group B(9/21=42.9%, 8 cases with persistent air leak more than 7days, including 2 wound dehiscence, one recurrence, and the other one case of empyema). In our experience, VATS has the effectiveness of thoracic surgery for treating thoracic problems, has resulted in surgical intervention in spontaneous pneumothorax.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.418-421
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• 1998

Thoracoscopic esophagectomy can be performed in esophageal diseases to reduce the postoperative complications. Recently, We encountered a case of esophageal cancer and successfully treated it by thoracoscopic esophagectomy with gastric pull-up. A 59-year-old male was presented with swallowing difficulty and an esophagogram, esophagoscopy, and chest CT showed an ulcerating tumor on the lower esophagus. The operation was performed in three stages: mobilization of the esophagus by thoracoscopic surgery, construction of a gastric tube through a laparotomy, and cervical anastomosis between the esophagus and the gastric pull-through. Hoarseness developed postoperatively, and the postoperative esophagogram showed leakage at the esophagogastric anastomotic site. The anastomotic leakage was healed following surgical drainage and the patient was discharged in good health. Hoarseness subsided spontaneously two months after surgery.

• Journal of Chest Surgery
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• v.34 no.5
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• pp.393-398
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• 2001

배경: 일차성 자연기흉의 재발방지를 위해서 폐기포절부위에 흡수성 셀룰로스망사와 Fibrin gluefm 도포하여 수술후 재발율을 줄일 수 있는 지 알아보았다. 대상 및 방법: 1996.4우러부터 2000.6월까지 2명의 술자가 222례의 일차성 자연기흉을 수술하였으며, 수술시기와 치료방법에 따라 4군으로 나누어 비교하였다. 제1군은 1996년부터 1997년가지 비디오흉강경수술 및 기계적 늑막유착술로 시술받은 군(25례), 제 2군은 같은 기간동안 액와개흉술 및 늑막유착술로 시술받은 군(53례), 제 3군은 1998년부터 2000.4월까지 흉강경수술 및 늑만유착술로시술받은 군(110례), 제 4군은 1999.7월부터 2000.6월까지 흉강경수술 및 봉합부위를 셀룰로스망사와 Fibrin glue로 보강한 군(34례)이었다. 각 군간, 엑스선상 기흉의 크기 및 폐기포의 수나 크기에 따라 재발율, 공기누출시간 및 흉관지속지간등을 일반선형모델을 사용하여 비교 분석하였다. 결과: 대상환자는 남자 203례, 여자 19례 이었고, 나이는 14게에서 68세이었고, 평균연령은 23.2$\pm$9.6세였다. 재발한 경우는제 1군이 5례(25%), 제 2군이 2례(3.8%), 제 3군이 5례(4.5%)이었고, 제 4군은 재발례가 없었다. 재발례는 모두 수술자의 수술경험이 2년이내일 때 발생하였다. 흉관지속기간은 제 4군이 제 3군(p<0.0006) 및 제1, 제2군(p<0.0001)에 비해서 더 짧았고, 술후 공기누출이 제 4군에서는 없었다. 술전흉부엑스선상 기흉의 크기에 따른 수술후 기흉의 재발울은 경도의 기흉에서 14.3%(2/14)이었고, 중등도 기흉에서 7.4%(10/134)이었으며, 심한 기흉에서는 재발례가 없었다. 재수술한 12례중 봉합부위근처에서 기포가 발행된 경우가 9례(75%)로 많았다. 결론: 재발방지를 위한 시술로 늑막유착술을 시행하지 않고 폐기포절제부위를 흡수성 셀룰로스망사와 Fibrin glue로 덮어주는 시술은 비교적 용이하며, 수술 후 공기 누출이 없었고, 수술 후 흉관지속기간이 더 짧았고, 단기간 추적에서 재발이 없었다. 재발에 영향을 미치는 것으로 흉부엑스선상 기흉의 크기가 작은 경우에는 재발율이 더 높았고, 수술자의 경험이 중요하였다.