• Journal of Gastric Cancer
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• v.12 no.3
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• pp.133-139
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• 2012

Laparoscopic gastrectomy has become widely used as a minimally invasive technique for the treatment of gastric cancer. When it was first introduced, most surgeons preferred a laparoscopic-assisted approach with a minilaparotomy rather than a totally laparoscopic procedure because of the technical challenges of achieving an intracorporeal anastomosis. Recently, with improved skills and instruments, several surgeons have reported the safety and feasibility of a totally laparoscopic gastrectomy with intracorporeal anastomosis. This review describes the recent technical advances in intracorporeal anastomoses using circular and linear staplers that allow for totally laparoscopic distal, total, and proximal gastrectomies. Data that demonstrate advantages in early surgical outcomes of a total laparoscopic method compared to laparoscopic-assisted operations are also discussed.

• Parasites, Hosts and Diseases
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• v.41 no.4
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• pp.239-242
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• 2003

Strongyloides stercoralis (SS) is an intestinal nematode that is mainly endemic in tropical and subtropical regions and sporadic in temperate zones. SS infection frequently occurs in people who have hematologic malignancies, HIV infection and in individuals undergoing immunosuppressive therapy. In this study, we report a 12year-old immunocompetent boy who was admitted to our hospital with acute abdomen. Laboratory evaluation showed strongyloidiasis, amebiasis and giardiasis. Clinical and laboratory findings immediately improved with albendazole therapy. Therefore, when diarrhea with signs of acute abdomen is observed, stool examinations should be done for enteroparasitosis. This approach will prevent misdiagnosis as acute abdomen. Complete clinical improvement is possible by medical therapy without surgical intervention.

• The korean journal of orthodontics
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• v.51 no.6
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• pp.428-434
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• 2021

Craniofacial clefts are extremely rare deformities. Tessier's classification is a widely accepted system that is based on clinical, radiographical, and surgical observations. The Tessier No. 0 cleft most commonly affects the upper lip, nose, and palate. This case presentation aims to report the outcome of a modified presurgical alveolar molding (PAM) appliance used in the treatment of an infant with Tessier No. 0 cleft as an alternate approach to mold such defects before surgery. The modified PAM appliance consisted of reciprocal parts connected by a helix. The segments were approximated by stripping the appliance at the midline in a V-shaped manner and the force was exerted by the extraoral elastics. The procedure gave results in 8 weeks, which may be regarded as a reasonable duration. The anterior cleft gap, which was 13 mm before the treatment, was reduced to 3 mm after the treatment by using modified PAM appliance. On a 21-month follow-up period, oral reshaping was regarded successful due to stability of the improved oral mold.

• Journal of Korean Neurosurgical Society
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• v.58 no.3
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• pp.236-241
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• 2015

Objective : We report on the technical feasibility and limitations of the transmanubrial approach for cervicothoracic junction (CTJ) lesions and emphasize the advantage of bisecting the upper part of the manubrium in an inverted Y-shape. Methods : Thirteen patients who underwent the fourteen transmanubrial approach for various CTJ lesions were enrolled during 2005-2014. For the evaluation of the accessibility for the CTJ lesion, we analyzed the two parallel line defined as a straight line parallel to the inferior and superior plateau of the upper and lower healthy vertebrae, the angle of the two parallel lines and the distance from the sternal notch to lines at the sternum on preoperative magnetic resonance images. Surgical limitations and perspectives, as well as postoperative clinical outcomes were evaluated retrospectively. Results : The CTJ lesions were six metastases, three primary bone tumors, two herniated discs, and one each of a traumatic dislocation with syrinx formation and tuberculous spondylitis and ossification of the posterior longitudinal ligament. If two parallel lines pass below the sternal notch, the manubriotomy should be inevitably performed. The mean preoperative Visual analogue scale score was 8 (range, 5-10), which improved to 4 (range, 0-6) postoperatively. Seven cases showed an increase in Frankel score postoperatively. Conclusion : The spatial relationship between the sternal notch and the two parallel lines to the lesion was rational to determine the feasibility of manubriotomy. The transmanubrial approach for CTJ lesions can achieve favorable clinical outcomes by providing direct decompression of lesion and effective reconstruction.

• Archives of Craniofacial Surgery
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• v.20 no.2
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• pp.101-108
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• 2019

Background: To date, a variety of surgical approaches have been used to reconstruct the medial orbital wall fracture. Still however, there is still a controversy as to their applicability because of postoperative scars, injury of anatomical structures and limited visual fields. The purpose of this study was to introduce a useful additional medial subbrow approach for better reduction and securement more accurate implant pocket of medial orbital wall fracture with the subciliary technique. Methods: We had performed our technique for a total of 14 patients with medial orbital wall fracture at our medical institution between January 2016 and July 2017. All fractures were operated through subciliary technique combined with the additional medial subbrow approach. They underwent subciliary approach accompanied by medial wall dissection using a Louisville elevator through the slit incision of the medial subbrow procedure. This facilitated visualization of the medial wall fracture site and helped to ensure a more accurate pocket for implant insertion. Results: Postoperative outcomes showed sufficient coverage without displacement. Twelve cases of preoperative diplopia improved to two cases of postoperative diplopia. More than 2 mm enophthalmos was 14 cases preoperatively, improving to 0 case postoperatively. Without damage such as major vessels or extraocular muscles, enophthalmos was corrected and there was no restriction of eyeball motion. Conclusion: Our ancillary procedure was useful in dissecting the medial wall, and it was a safe method as to cause no significant complications in our clinical series. Also, there is an only nonvisible postoperative scar. Therefore, it is a recommendable surgical modality for medial orbital wall fracture.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.34-40
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• 2009

Background: The principal surgical technique for treating an abdominal aortic aneurysm since the 1960s has been the transperitoneal approach, yet there have been some recent studies that have reported improved surgical results with using the retroperitoneal approach. However, there are only limited clinical Korean studies that have, compared between the transperitoneal and retroperitoneal approaches. Material and Method: This study included 36 patients who had been diagnosed as having an aneurysm of the abdominal aorta and they were surgically treated between January 2001 and July 2007. The patients were subdivided into the retroperitoneal approach group (n=17) and the transperitoneal approach group (n=19), and they were compared in terms of the preoperative risk factors, the postoperative complications and the operative mortality. The risk factors of operative mortality risk and long-term survival for the 36 patients were assessed by the Kaplan-Meier method. Result: There were no significant differences between the groups in terms of gender, age, the underlying disease, a history of smoking, rupture of aneurysm, the preoperative symptoms, the operation time and the incidence of postoperative complications. However, the duration of postoperative fasting, the number of days of having an indwelling nasogastric tube and the length of the stay in the intensive care unit were significantly short for the retroperitoneal approach group (p<0.05). There was a 16.7% rate of operative mortality (6/36) and five of the deaths were attributed to preoperative ruptured aneurysm. On univariate analysis, a higher preoperative serum creatinine level (SCr ${\geq}$1.8 mg/dL, p=0.016) and ruptured aneurysm (p<0.001) were the significant risk factors of operative mortality. As assessed by the Kaplan-Meier method, the long-term survival was comparable between the groups and the five-year survival rate of all the patients was 57.5%. Conclusion: In the present study, a retroperitoneal approach has several advantages such as a shorter intensive care unit stay, a shorter duration of postoperative fasting and a shorter duration of an indwelling nasogastric tube. Therefore, unless there is any contraindication for a retroperitoneal approach, it could be considered as a primary surgical access for repairing an abdominal aortic aneurysm.

• Journal of Korean Foot and Ankle Society
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• v.16 no.4
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• pp.247-256
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• 2012

Purpose: This study was performed to evaluate the clinical outcomes of operative treatment using mini-open sinus tarsi approach for displaced intraarticular calcaneal fractures. Materials and Methods: We studied 18 cases (16 patients) of intraarticular calcaneal fractures who were treated with sinus tarsi approach by same surgeon. The mean age of patients was 44.8 years, and mean follow-up period was 17.2 months. The measurement of B$\ddot{o}$hler angle, Gissane angle, the degree of articular surface depression, and the period to union were performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). Results: B$\ddot{o}$hler angle and Gissane angle had improved significantly from preoperative average $9.8^{\circ}$, $117.6^{\circ}$to average $22.4^{\circ}$, $113.4^{\circ}$ immediate postoperatively, and had maintained to average $21.8^{\circ}$and $114.2^{\circ}$ at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 5.2 mm to 1.2 mm at the last follow-up. All cases achieved bone union, and the period to union was average 10.5 weeks. AOFAS score was average 86.2 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the CNHF scale. Therefore, 16 cases (88.8%) achieved satisfactory results. Conclusion: The minimally invasive sinus tarsi approach using headless compression screw seems to be an effective surgical method for displaced intraarticular calcaneal fractures, because of the possibility of accurate restoration of articular surface and the low risk of postoperative soft tissue complications.

• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.67-75
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• 2009

Purpose: This study evaluated the clinical outcomes of debridement arthroplasty using the posteromedial approach in elbow joints with pain and bony limitation of motion. Materials and Methods: This study involved 16 elbows in 16 patients with pain and bony limitation of motion, which were treated by debridement arthroplasty using the posteromedial approach from March 2005 to March 2008. The mean follow up period was 27.6 (13~52) months. The clinical outcomes were analyzed using the Visual Analogue Scale(VAS) for pain scale, the preoperative and postoperative range of motion and the Mayo Elbow Performance Scores(MEPS). Results: The VAS was decreased significantly from a preoperative mean of 4.5 to a postoperative mean 1.1 (p<0.001). The average arc of motion improved significantly from $61.6 (0~90)^{\circ}$ preoperatively to $109.4 (80-120)^{\circ}$ postoperatively (p<0.001). The MEPS also improved significantly from 59.4 to 85.6 postoperatively (p<0.001). There were no complications, such as hematoma and elbow instability. Conclusion: Debridement arthroplasty using the posteromedial approach is a useful surgical procedure in the elbow joint with pain and bony limitation of motion, where all compartments can be debrided, the ulnar nerve can be manipulated easily and damage to the medial collateral ligament can be minimized.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.328-341
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• 1987

We reviewed 147 cases of primary carcinoma of the lung between January 1975 and December 1986 at the Thoracic and Cardiovascular Department, Yonsei university College of Medicine, Seoul, Korea. There were 116 males and 31 females with 93.72% ranging in age from 40 to 69 years. The mean age was 61.01 years. To 69 years of age with 61.01 years of mean age. There were 92 [62.59%] cases of squamous cell carcinoma, 29 [19.73%] cases of adenocarcinoma, 8 [5.44%] cases of undifferentiated large cell carcinoma, 8 [5.44%] cases of undifferentiated small cell carcinoma and 10 [6.8%] cases of bronchoalveolar cell carcinoma. 50 [34.01%] patients in stage I and 49 [33.26%] patients in stage II underwent pneumonectomies and lobectomies with a 67.27% rate of resection, where as only 49.12% of stage III patients were resected. Also 7 [30.43%] of the 23 stage IV cases were surgically resected and confirmed stage IV after surgical resection. The actuarial survival rate according to classification are as follows. The one and 3 year survival rate of the patients in stage I were 96% and 84% respectively. The one and `3 year survival rate of the patients in stage II were 100% and 66.6%, whereas the one and 3 year survival rate of the patients in stage III, T3 were 78.57% and 69.84%. The survival rates of patients in stage I, II, III T3 were better than those of the other stages. There were significant differences in observed survival for patients with stage II as compared with the patients with stage Ill, T3. [p=0.0005]. An aggressive surgical approach still offered the greatest chance for long-term survival even in stage Ill, T3. The survival rate in patients with resectable cases including stage III, T3 might be improved with an aggressive surgical approach. The one and 3 year survival rates of patients in stage III, N2 were 56.67% and 43.7 I%. The one and 3 year survival rates of patients in stage IV were 21.43% and 3.57%. Patients in stage III, N2 or IV had markedly decreased survival rates. When the carcinoma cell type was the basis for the determination of rate of survival, the result were as follows; The one, 3 and 5 year survival rates of squamous cell carcinoma were 78.33%, 60.19%, and 57.32%, and the one and 3 year survival rates of adenocarcinoma were 55.56% and 44.49%. The survival rates of large cell carcinoma were 66.67%, and 44.45%, at one, three and five years respectively. The one and 3 year survival rates of bronchoalveolar cell carcinoma were 71.43% and 47.62%, the one, 3 and 5 year survival rates of small cell carcinoma were 40%, 20% and 20%. The survival rate of squamous cell carcinoma was better than that of other cell carcinomas, the survival rate of small cell carcinoma was the worst. The operative mortality rate was 1.36%. There were 10 cases of post-operative complications including 2 cases of bleeding which required further surgery, 2 cases of wound infection, and 4 cases of empyema thoracis. The length of survival of three of the empyema thoracis cases was 16, 98 and 108 months respectively, Four male patients all older than 47 years survived more than 9 years, post surgery, although one developed empyema thoracis. These four cases were initially classified as 2 cases of stage I and one each of stage II and stage III, T3. We have concluded that the survival rates of patients in stages I, II and III, T3 were improved after complete surgical resection.

• Journal of Korean Neurosurgical Society
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• v.40 no.1
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• pp.58-62
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• 2006

Objective : Development of diagnostic tools has resulted in early detection of thoracic disc herniations[TDH] even when the herniated disc is soft in consistency. In some of the cases, it is considered better not to opt for surgical treatment due to the unduly high morbidity and potential complications associated with conventional approaches. The authors have applied percutaneous endoscopic thoracic discectomy[PETD] technique to soft TDHs in order to avoid the morbidity associated with conventional approaches. Methods : Eight consecutive patients [range, 31 to 75 years] with soft lateral or central TDH [from T2-3 to T11-12] underwent PETD between May 2001 and June 2004. The patient was positioned in a prone position with intravenous sedation and local anesthetic infiltration. The authors introduced a cannula into the thoracic intervertebral foramen using endoscopic foraminoplasty technique. Discectomy was performed with mechanical tools and a laser under continuous endoscopic visualization and flu oroscopic guidance. Functional status was assessed preoperatively and postoperatively using the Oswestry Disability Index[ODI]. Results : The mean ODI scores improved from 52.8 before the surgery to 25.8 at the final follow-up. In cases of myelopathy, long tract signs showed improvement. The mean operative time was 55 minutes, and no patient required conversion to open surgery. Conclusion : The technique allows a smaller incision and less morbidity. Soft TDH is amenable to this minimally invasive approach in selected patients with myeloradiculopathy.