• Journal of Chest Surgery
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• v.53 no.1
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• pp.38-40
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• 2020

Bronchobiliary fistula is a rare disease defined as an abnormal connection between the biliary tract and the bronchial tree. We report the successful surgical repair of bronchobiliary fistula. A 78-year-old man underwent surgery and several rounds of transcatheter arterial chemoembolization and radiofrequency ablation as treatment for hepatocellular carcinoma. He presented with greenish sputum and chronic cough for several months, and his symptoms did not resolve after endoscopic treatment. We performed lobectomy of the right lower lobe and omentopexy for bronchobiliary fistula under laparotomy and thoracotomy. The bronchobiliary fistula was successfully closed, and the bilious sputum disappeared after surgery.

• Journal of Chest Surgery
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• v.57 no.2
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• pp.152-159
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• 2024

Background: Anastomotic leakage (AL) following esophagectomy represents a serious complication that often results in prolonged hospitalization and necessitates repeated interventions, including nothing-by-mouth (NPO) restriction, endoscopic vacuum therapy (EVT), or surgical repair. In this study, we evaluated the patterns and outcomes of AL treatment. Methods: We retrospectively reviewed the medical records of patients who underwent esophagectomy for esophageal cancer at a single center between 2003 and 2020. Of 3,096 examined cases, 181 patients (5.8%) with AL were included in the study: 114 patients (63%) with cervical anastomosis (CA) and 67 (37%) with intrathoracic anastomosis (TA). Results: The incidence of AL was 11.9% in the CA and 3.2% in the TA group (p<0.001). Among patients with CA who developed AL, 87 (76.3%) were managed with NPO, 15 (13.2%) with EVT, and 12 (10.5%) with surgical repair. Over 90% of patients with cervical AL resumed an oral diet by the time of discharge, regardless of treatment method. Among patients with TA and AL, 36 (53.7%) received NPO, 25 (37.7%) underwent EVT, and 6 (9%) required surgery. Of these, 34 patients who were managed with NPO and 19 with EVT could resume an oral diet. However, only 2 patients who underwent surgery resumed an oral diet, and 2 patients required additional EVT. Conclusion: Although patients with CA displayed a higher incidence of AL, their rate of successful oral intake exceeded that of those with TA, regardless of treatment method. Among patients exhibiting AL with TA, EVT was more commonly employed than in CA cases, and it appears effective.

• Journal of Chest Surgery
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• v.21 no.1
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• pp.169-174
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• 1988

Thoracic esophageal rupture caused by blunt trauma is often not recognized until late because of the vague symptoms in the initial state as well as its rare incidence, which can easily lead to fulminant mediastinitis with frequent fatal outcome. Once extensive mediastinitis occurs, the primary surgical repair of the esophageal tear is considered to be practically impossible. Various methods have been proposed for the management of these desperately ill patients, but no one provides an acceptable good result yet. The purpose of this article is to report the successful result obtained in the treatment of a patient with fulminant mediastinitis from traumatic esophageal rupture by continuous transesophageal irrigation. A 27 year-old male patient was brought to the emergency room of our hospital complaining of dyspnea and chest pain after blunt trauma. The diagnosis of esophageal rupture in the thorax was made late, about 46 hours after the initial injury, when mediastinitis had already progressed. The transesophageal irrigation method was immediately instituted which consisted of profuse transesophageal irrigation of the mediastinum with orally ingested fluid and/or by Levin tube, positioned proximal to the site of the rupture, and drainage of the irrigation fluid by thoracoscopically accurately positioned chest tubes connected to a well suctioning system. With subsiding inflammatory signs and symptoms, the esophagogram, obtained 54 days after the treatment, showed no evidence of the mediastinal leakage of contrast material which contrasted previous esophagograms with definitive dye collections in the mediastinum. Additional endoscopic finding confirmed complete healing of the esophageal mucosa, previously ruptured. He has been followed up without any problem until recently, 6 months after discharge.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.825-830
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• 2007

Background: Minimally invasive cardiac surgery appears to offer certain advantages such as earlier postoperative recovery and a greater cosmetic effect than that achieved through conventional sternotomy. However, this approach has not yet been widely adopted in Korea to replace complex open heart surgery such as mitral valve reconstruction. This study compared the results of robot assisted minimally invasive mitral valve repair with those results of conventional sternotomy. Material and Method: From December 1993 to December 2005, 520 consecutive patients underwent mitral valve reconstruction for mitral regurgitation in our institution. These patients were subdivided according to those whose surgery used the conventional sternotomy approach (Group S, n=432) and those who underwent minimally invasive right anterior thoracotomy (Group M, n=88); we then compared the clinical results of both groups. When we performed minimally invasive right thoracotomy, we used a robot (AESOP 3000) and made an incision less than 5 cm. Result: Our study patients in both groups were similar for their age, gender and preoperative ejection fraction. There were two hospital mortalities in group S. but there was no mortality in the group M patients. Significant reductions in the ICU stay and the postoperative hospital stay were observed in the group M patients compared with the group S patients. However, both the bypass time and the aortic cross-clamp time were significantly longer in the group M patients. In spite of the confined incision in the group M patients, there were no limitations on the mitral valve repair techniques. There was a similar frequency of postoperative significant residual mitral regurgitation in both groups. Conclusion: In this study, the minimally invasive mitral valve repair showed comparable early results with the conventional sternotomy patients. We will now need long-term follow-up of these patients who underwent minimally invasive mitral valve repair, but we anticipate that based on the results of this study, we will begin to routinely perform minimally invasive cardiac surgery as out primary approach for mitral valve reconstruction.

• Journal of Korean Neurosurgical Society
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• v.50 no.6
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• pp.503-506
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• 2011

Objective : The aim of this study was to assess the safety and efficacy of radiation-sterilized allografts of iliac bone and fascia lata from cadaver specimens to repair skull base defects after transsphenoidal surgery. Methods : Between May 2009 and January 2010, 31 consecutive patients underwent endonasal transsphenoidal surgery and all patients received sellar reconstruction using allografts following tumor removal. The allografts were obtained from the local tissue bank and harvested from cadaver donors. The specimens used in our approach were tensor fascia lata and the flat area of iliac bone. For preparation, allografts were treated with gamma irradiation after routine screening by culture, and then stored at $-70^{\circ}C$. Results : The mean follow-up period after surgery was 12.6 months (range, 7.4-16 months). Overall, postoperative cerebrospinal fluid (CSF) leaks occurred in three patients (9.7%) and postoperative meningitis in one patient (3.2%). There was no definitive evidence of wound infection at the routine postoperative follow-up examination or during re-do surgery in three patients. Postoperative meningitis in one patient was improved with the use of antibiotics and prolonged CSF diversion. Conclusion : We suggest that allograft materials can be a feasible alternative to autologous tissue grafts for sellar reconstruction following transsphenoidal surgery under selected circumstances such as no or little intraoperative CSF leaks.

• Archives of Craniofacial Surgery
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• v.9 no.2
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• pp.101-104
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• 2008

Purpose: Diplopia and cosmetically unacceptable enophthalmos are the major complications of blow out fracture. Prolapse of orbital tissue into the sinuses, enlarged orbital volume, atrophy of orbital fat and loss of support of orbital walls play a role in the pathogenesis of enophthalmos. To correct post-traumatic enophthalmos, freeing of incarcerated orbital contents combined with reduction of bony orbital volume and reconstruction of suspensory support of globe is necessary. But remained enophthalmos after surgical treatment is difficult to correct completely. In this case, the authors performed implant insertion for affected orbit and endoscopic orbital decompression for unaffected orbit for correction of late enophthalmos. Method: We reviewed a girl patient with right inferomedial orbital wall blow out fracture, right zygoma fracture treated at our hospital for correction of enophthalmos. An 18-year-old female had sustained posttraumatic enopthalmos. Two surgical management was performed for correction blow out fracture at the other hospital. But residual diplopia, enophthalmos, cheek drooping were found. And then she transferred to our hospital. She had severe enophthalmos(5 mm) also had diplopia and extraocular muscle limitation. We performed operation for correction of enophthalmos. After operation, she showed minimal improvement of diplopia and enophthalmos(3 mm). The authors make plan for operation for correction enophthalmos due to cosmetical improvement. Implant insertion was performed for affected orbit. For unaffected orbit, nasoendoscopic medial orbital wall decompression was proceeded. Result: Correction of enophthalmos was found after operation and was maintained for nine years follow-up. Patient expressed satisfaction for the result. Conclusion: To correct persistant enophthalmos, we could have satisfactory result with orbital wall reconstruction on affected eye and decompression on unaffected eye.

• Journal of Chest Surgery
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• v.56 no.6
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• pp.420-430
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• 2023

Background: This study provides an update to a landmark 2004 report describing demographics, training, and trends in adherence to thoracic surgery practice standards in Canada. Methods: An updated questionnaire was administered to all members of the Canadian Association of Thoracic Surgeons via email (n=142, compared to n=68 in 2004). Our report incorporates internal data from Ontario Health and the Canadian Partnership Against Cancer. Results: Forty-eight surgeons completed the survey (male, 70.8%; mean±standard deviation age, 50.3±9.3 years). This represents a 33.8% response rate, compared to 64.7% in 2004. Most surgeons (69%) served a patient population of over 1 million per center; 32%-34% reported an on-call ratio of 1:4-1:5 days, and the average weekly hours worked was 56.4±11.9. Greater access to dedicated geographic units per center (73% in 2021 vs. 53% in 2004) has improved thoracic-associated services and house staff, notably endoscopy units (100% vs. 91%), with 73% of respondents having access to both endobronchial and endoscopic ultrasound. Access to thoracic radiology has also improved, particularly regarding positron emission tomography scanners per center (76.9% vs. 13%). Annual case volumes for lung (255 vs. 128), esophageal (41 vs. 19), and mediastinal resections (30 vs. 13), along with hiatal hernia repair (45 vs. 20), have increased substantially despite reports of operating room availability and radiology as rate-limiting steps. Conclusion: This survey characterizes compliance with current practice standards, addressing the needs of thoracic surgeons across Canada. Over 85% of respondents were aware of the 2004 compliance paper, and 35% had applied for resources and equipment in response.

• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.920-926
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• 2006

Background: Mortality and morbidity of anastomotic complications after esophagectomy have gradually decreased in recent years. However, swallowing difficulties and reflux symptoms after esophagogastrostomy continue to be a burden jeopardizing the quality of life. In the present study, we evaluated the quality of esophagogastrostomy by analyzing anastomotic stenosis and reflux esophagitis. Material and Method: A retrospective analysis was made in 74 patients who underwent esophagogastrostomy after esophagectomy by one surgeon between January 1995 and December 2004. 53 patients of them received endoscopic examination during follow-up($29{\pm}23.6$ months, range $5{\sim}111$ months). Reflux esophagitis and stenosis at anastomostic site were analyzed according to the techniques and locations of esophagogastrostomy. Result: The median age at the time of repair was $60.3{\pm}8.87$ years(range $39{\sim}81$ years). 23 patients received a hand-sewn esophagogastric anastomosis and 30 patients a circular stapled one. There was no significant statistical difference in terms of anastomotic stenosis(p=0.64) and reflux esophagitis(p=0.41) between the two groups. Cervical anastomosis was peformed in 26 patients and intrathoracic anastomosis in 27 patients. No significant statistical difference in anastomotic stenosis between the two groups was found(p=0.44), but reflux esophagitis was noted in 3 patients in the cervical anastomosis group and 14 patients in the intrathoracic anastomosis group(p=0.003). Conclusion: Cervical anastomosis was supposed to have a better quality of esophagogastrostomy by lowering the risk of reflux esophagitis. In the future, the comprehensive study including a patient's subjective symptom and Barrett's metaplasia should be performed in larger cases.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.598-604
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• 2008

Background: The improvements in endoscopic equipment and surgical robots has encouraged the performance of minimally invasive cardiac operations. Yet only a few Korean studies have compared this procedure with the sternotomy approach. Material and Method: Between December 2005 and July 2007, 48 patients (group A) underwent minimally invasive cardiac surgery with AESOP through a small right thoracotomy. During the same period, 50 patients (group B) underwent conventional surgery. We compared the operative time, the operative results, the post-operative pain and the recovery of both groups. Result: There was no hospital mortality and there were no significant differences in the incidence of operative complications between the two groups. The operative $(292.7{\pm}61.7\;and\;264.0{\pm}47.9min$, respectively; p=0.01) and CPB times ($128.4{\pm}37.6\;and\;101.7{\pm}32.5min$, respectively; <0.01) were longer for group A, whereas there was no difference between the aortic cross clamp times ($82.1{\pm}35.0\;and\;87.8{\pm}113.5min$, respectively; p=0.74) and ventilator times ($18.0{\pm}18.4\;and\;19.7{\pm}9.7$ hr, respectively; p=0.57) between the groups. The stay on the ICU $(53.2{\pm}40.2\;and\;72.8{\pm}42.1hr$, respectively; p=0.02) and the hospitalization time ($9.7{\pm}7.2\;and\;14.8{\pm}11.9days$, respectively; p=0.01) were shorter for group A. The Patients in group B had more transfusions, but the difference was not significant. For the overall operative intervals, which ranged from one to four weeks, the pair score was significantly lower for the patients of group A than for the patients of group B. In terms of the postoperative activities, which were measured by the Duke Activity Scale questionnaire, the functional status score was clearly higher for group A compared to group B. The analysis showed no difference in the severity of either post-repair of mitral ($0.7{\pm}1.0\;and\;0.9{\pm}0.9$, respectively; p=0.60) and tricuspid regurgitation ($1.0{\pm}0.9\;and\;1.1{\pm}1.0$, respectively; p=0.89). In both groups, there were no valve related complications, except for one patient with paravalvular leakage in each group. Conclusion: These results show that compared with the median sternotomy patients, the patients who underwent minimally invasive surgery enjoyed significant postoperative advantages such as less pain, a more rapid return to full activity, improved cosmetics and a reduced hospital stay. The minimally invasive surgery can be done with similar clinical safety compared to the conventional surgery that's done through a median sternotomy.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.366-370
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• 2005

Background: In general, cardiac surgery has been performed via median sternotomy. During the past decade, improvements in endoscopic equipment and operative techniques have resulted in development of minimally invasive cardiac operation using small incisions. With the advent of a voice controlled camera-holding robotic arm (AESOP 3000, Automated Endoscope System for Optimal Positioning), cardiac surgery entered the robotic age. Material and Method: Between April 2004 and December 2004, a total of seventy eight patients underwent robotic cardiac surgery, of whom sixty four patients underwent robot-assisted minimally invasive cardiac surgery via 5cm right lateral minithoracotomy using voice controlled robotic arm, femoral vessels cannulation, percutaneous internal jugular cannulation, transthoracic aortic cross clamp. Other fourteen patients underwent MIDCAB via internal mammary artery harvesting using AESOP. Result: Robotic cardiac surgery were mitral valve repair in 37 cases, mitral valve replacement in 10 cases, aortic valve replacement in 1 case, MIDCAB in 14 cases, ASD operation in 9 cases, and isolated Maze procedure in 1 case. In mitral operation, mean CPB time was $165.3\pm43.1$ minutes and mean ACC time was $110.4\pm48.2$ minutes. Median length of hospital stay was 6 days (range 3 to 30) in mitral operation, 4 days (range 2 to 7) in MIDCAB, and 4 days (range 2 to 6) in ASD operation. For complications, 3 patients were required by reoperation for bleeding. There was no hospital mortality. Conclusion: Our experience of robot cardiac surgery suggests that many cardiovascular surgeons will be able to perform minimally invasive cardiac operations through small incisions with robot-assisted video-direction. Well-designed studies and close long-term follow-up will be required to analyze the benefits of robot-assisted operation.