• Journal of Chest Surgery
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• v.29 no.7
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• pp.763-768
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• 1996

This report is an analysis of 43 cases of primary mediastinal tumors and cysts which were treated in the Department of Thoracic and Cardiovascular Surgery, Tae Jeon Eul li General Hospital from January, 1986 to April, 1995. There were 19 males and 24 females, and their ages ranged from 4 years to 68 years, with mean age of 31.3 years. The most common symptoms were dyspnea 48.8%, chest disconyort 39.5%, cough )4.9%, and chest pain 23.3%, and the most frequently encountered location of tumor was anterior mediastinum followed by posterior, and middle mediastinum. From the pathologic viewpoint, teratoma was the most frequent type followed by neurogenic tumors, cysts, thymoma, and Iymphoma. The most useful diagnostic method was plain X-ray examination of the chest, and final diagnosis could usually be made only after an operation. All of benign tumors were completely removed and malignant tumors were treated with chemotherapy and radiotherapy after operation There were 7 (16.3 %) cases of postoperative complications, and there was no postoperative mortality.

• Journal of Chest Surgery
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• v.35 no.11
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• pp.807-811
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• 2002

Due to its less invasive nature and superior visual field, video-assisted thoracescopic excision of mediastinal mass is thought to be comparable to open thoracotomy. Material and Method : From January 1995 to August 2001, the medical records of 38 patients who underwent video-assisted thoracoscopic excision of mediastinal mass was retrospectively analyzed. The outcome of these patients were compared with 5 patients who converted to thoracotomy Result: Male to female ratio was 13(34.2%) : 25(65.8%), and mean age was 39.2$\pm$35.4 years. Regarding the pathology, there were 8 neurilemmomas(21.1%), 6 thymic cysts (15.8%), 5 teratomas(13.2%), 5 ganglioneuromas(13.2%), 4 bronchogenic cysts(10.5%), 3 pericardial cysts(7.9%), 3 thymomas(7.9%), and 2 lymphangiomas(5.3%). The mean operation time was 110.6$\pm$7.0 minutes, mean postoperative tube stay was 4.2$\pm$0.4 days, mean postoperative hospital stay was 5.2$\pm$0.4 days, and mean number of injection of analgesics was 1.9$\pm$0.4 times. Although the mean values for the above indices were less than those of the thoracotomy conversion cases, they were statistically insignificant. Postoperative complications of videoassisted thoracoscopic excision included chylothorax, prolonged air leakage, and unilateral phrenic nerve palsy, all of which recovered before patient discharge. There was, however, permanent unilateral ptosis in one patient. Conclusion : As video-assisted thoracoscopic excision of mediastinal mass is safe, less painful, conducive to earlier recovery and cosmetically more appealing, a more active application of this technique is recommeded.

• Journal of Chest Surgery
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• v.31 no.1
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• pp.40-45
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• 1998

Recently, video-assisted thoracoscopic surgery for mediastinal lesions has been considered a new effective therapeutic method. From March, 1992 to April, 1997, 33 cases of video assisted thoracoscopic surgery for mediastinal lesions were performed. Gender distribution was 16 males and 17 females. Average age was 42 years old(ranged from 14 to 69). The locations of lesions were anterior mediastinum in 14 cases, middle mediastinum in 5 cases, posterior mediastinum in 11 cases, and superior mediastinum in 3 cases. These included 9 neurilemmomas, 5 benign cystic teratoma, 4 pericardial cysts, 2 ganglioneuroma, 2 thymus, 2 thymic cyst, 1 thymoma, 2 esophageal leiomyomas, 1 dermoid cyst, 1 lipoma, 1 malignant lymphoma, 1 bronchogenic cyst, 1 pericardial effusion, and 1 Boerhaave's disease with empyema. Working window was needed in 6 cases. We converted to open thoracotomy in 6 cases. Reasons of convertion to open thoracotomy were large sized mass(1), severe adhesion(3), and difficult location to approach(2). The average operation time was 116min($\pm$56 min). The average chest tube drainage time was 4.7days. The average hospital stay was 8.7 days. Operative complications were atelectasis(2), empyema with mediastinitis(1), recurrent laryngeal nerve palsy(1), and plenic nerve palsy(1). In conclusion, VATS for mediastinal lesions were performed with shorter operation time and hospital stay, and lesser complications and pain than those of conventional thoracotomy.

• Journal of Yeungnam Medical Science
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• v.6 no.2
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• pp.79-90
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• 1989

Computerized Tomography is now well established and important noninvasive method of diagnosting mediastinal mass lesions because of its superior imaging of their size, location and internal composition. Authors ana lysed and present CT findings of 30 surgically proven mediastinal tumors and cysts that were studied and treated at the Yeungnam University Hospital during recent 6 years. The most common tumor was thymona(9 cases), and teratoma(6 cases), lymphoma(6 cases), bronchogenic cyst(4 cases), neurogenic tumor (4 cases), pericardial cyst(1 case) were next in order of frequency. There were 5 cases of thymoma showing homogenous solid density mass, 2 cases were malignant thymoma and myasthenia gravis was present in 2 cases. A case of thymolipoma and a case of thymic carcinoma were included. All teratomas were cystic masses but pathognomic fat, and calcified density were seen only in 4 cases. 5 cases were located in anterior mediastinum and 1 case was in posterior mediastinum. Lymphoma(3 Hodgkin's and 3 non-Hodgkin's) appeared as irregular lobulated mass in anterior mediastinum. Neurogenic tumor(2 ganglioneuroma and 2 neurilemmoma) appeared as homogenous density mass located in posterior mediastinum. Among the 4 bronchogenic cysts, 2 were located in retrotracheal area, 1 was located in subcarinal and 1 was in parathoracic area. One case of pericardial cyst was oval shaped cystic mass located in left pericardiac border.

• Journal of Chest Surgery
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• v.30 no.8
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• pp.780-785
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• 1997

Mediastinal tumor had been fascinated by its location on heart, great vessels, esophagus, and nervous tissue, its convenience of surgical treatment and superiority of its operative result. Between January 1989 and June 1995, eighty-seven patients with mediastinal tumor which were treated surgically in the Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, School of Medicine, University of Ulsan. To provide the appropriate surgical management of mediastinal tumor, the demographic data, diagnostic evaluation, clinical presentation, location, size, operative finding and histopathologic distribution were reviewed and we analyzed relativity between invasiveness in chest computed tomographic finding or invasiveness on operative finding and histopathologic invasiveness. The anterosuperior mediastinum was the most commonly involved site of a mediastinal tumor(57%), followed by the posterior mediastinum(35%) and middle mediastinum(8%). The most frequently encountered tumors were thymic neoplasia(31%), followed by primary cyst(22%), neurogenic tumor(22%) and teratoma(10%) in decreasing order of frequency. Histopathologically invasive tumors were present in 17 patients(20%) and its site included anterosuperior mediastinum(16%) and posterior mediastinum(4%). All patients in this study underwent chest CT. In chest CT's finding, 15 patients(17%) showed invasiveness. A total excision of the tumor was performed 80 patients(92%), subtotal excision 6 patients(7%) and biopsy only 1 patient(2%). In operative finding, 14 patients(16%) were suspected invasiveness. The mean size of the tumor was 6.0$\pm$ 3.2cm. In anterosuperior mediastinum, the mean size was 6.2$\pm$3.1cm, in middle mediastinum, it was 3.9$\pm$1.1cm, in posterior mediastinum, it was 5.8$\pm$2.6cm. In malignant tumors, the mean size was 7.3$\pm$4.6cm, in benign tumor, it was 5.5$\pm$2.6cm(P<0.05). Relativity between histopathological invasiveness(17 patients) and invasiveness in chest CT's finding(15 patients) included sensitivity 35%, specificity 87% and predictability 35%, relativity between histopathological invasiveness(17 patients) and invasiveness on operative finding included sensitivity 52%, specificity 93% and predictability 64%. In conclusion, since it was proved that the compatibility of preoperative chest CT findings or operative findings and histopathological invasiveness is quite low, it is considered that wide excision of the mediastinal tumor except cystic lesion including adjacent tissues would yield better postoperative results.

• 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 Chest Surgery
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• v.25 no.12
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• pp.1383-1390
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• 1992

This is the result of the annual statistic analysis of thoracic and cardiovascular surgical cases in 1991, Korea. 14,715 cases of surgery[thoracic 8,995/cardiovascular 5,720] were done by 53 institutes replied. The order of frequency of cell type in primary lung cancer was squamous [62.3%] / adeno [23.9%] / small [6.4%] / adenosquamous [3.0%], and in mediastinal tumor, neurogenic[27.l%] / thymoma [27.1%] / teratoma[26.4%] / congenital cystic[12.0%]. Surgery for tuberculosis was decreased to 15.8% of overall infectious disease from the recent 6 year`s average 35.7%. In general thoracic surgery, the single most frequent operation was closed thoracostomy[4,047 cases] for pleural pathology. The ratio of congenital to acquired heart disease was 2:1, and acyanotic to cyanotic was 3:1. The order of frequency of congenital acyanotic heart disease was VSD [45.6%] / ASD [25.6%] / PDA [20.4%] / PS [2.9%], and that of cyanotic heart disease was TOF [42.6%] / PA [12.9%] / TGA [9.9%] / DORV [8.8%]. In 1,364 cases of valvular surgery, single mitral pathology was the most frequent candidate[729 cases, 53.4%]. In 243 cases of coronary surgery, bypassing graft materials were great saphenous vein[41.6%], internal mammary [39.5%], and artificial vessel[18.9%]. There were no specific differences in aortic surgery, assisted device implantation, and antiarrhythmic surgery as compared to previous study. This nation-wide inquiry will be continued and reported annually by KTCS Society.

• Journal of Chest Surgery
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• v.25 no.5
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• pp.504-510
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• 1992

Overall 25,095 cases of general thoracic surgery were analysed, which were performed by 48 institutes in Korea during recent 6 years[242 hospital-years]. The proportions of tumorous disease and infectious disease to be operated were 6,864 cases[27.4%] and 6,775 cases [27.0%], The most common organ involved for operation was lung-bronchus 16,542 cases [69.5%], and remainders were pleura 2,500 [10.0%], esophagus 2,433[9.7%], mediastinum 1,902[7.6%], chest wall 1,297 [5.2%], and diaphragm 421 [1.7%] in order. Among 6,864 cases of tumorous diseases, the most common causes for operation were lung-bronchus tumor 3132 cases [45.6%] and most of them were lung cancer 2,731 cases [88.7%]. In the 2,019 cases of primary lung cancer with known cell type, squamous cell carcinoma 1,296 cases [64.2%] and adenocarcinoma 460 cases [22.8%] were the most. The common types in the 1,207 cases of mediastinal tumor with known cell type were neurogenic tumor 348 cases [28.8%], thymoma 311 [25.8%], and teratoma 252[20.9%]. The annual cases of operation for tumorous disease including malignant tumor were increased steadily. Operation for infectious lung diseases [including bronchiectasis and tuberculosis] were about twice common than infectious pleural disease [i.e. empyema], and operations for tuberculous disease occupied about half cases of infectious lung disease. In 11,456 cases of other disease entities, excluding tumorous and infectious disease, there were bullous lung disease 9,074 cases[79.2%], benign esophageal disease 484[4.2%], myasthenia gravis 356[3.1%], chest wall deformity 483[4.2%], and diaphragmatic lesion 421[3. 7%] in order. We propose that above results for inquiry can be used as the basic data of general thoracic surgery in Korea.

• Journal of Chest Surgery
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• v.34 no.10
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• pp.787-791
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• 2001

Coronary artery aneurysm is a rare disorder. It is defined as abnormal dilatation of coronary artery with diameter exceeding 1.5 times the adjacent normal segments. The incidence of coronary aneurysm is 2.6% in Caucasians and 0.25% in Asians. Over half of the former were associated with atherosclerotic coronary artery disease. However, 70 percents of the latter were nonobstructive coronary artery aneurysms. Coronary artery fistula is a rare disorder. It has been identified in only 0.2% of routine cardiac angiographic studies conducted over a 10-year period. The clinical spectrums are various, asymtomatic, asymptomatic murmur, dyspnea on exertion, fatigue, and congestive heart failure. The right coronary artery (56%) and left coronary artery(36%) are mainly involved in the origin site of congenital coronary artery fistula. The draining site of fistula are right ventricle(39%), right atrium(33%), and pulmonary artery(20%) and so on. This 54 years-old woman had intermittent chest tightness and an abnormal mediastinal shadow on chest roentgenogram and chest C-T examination, which was diagnosed as a mediastinal mass such as teratoma. We performed the operation under left anterolateral thoracotomy for mass excision. However, we knew the mass had the pulsating arterial blood flow through a fine needle puncture of the mass and that it was attached to the left ventricle. We believed the excision of mass on beating heart would be very dangerous. Therefore, we closed the wound without excising the mass. After several days, we performed an echocardiography and coronary angiography, We knew it was cardiac tumor. Incidentally, the patient had a tortuous coronary fistula from the right coronary artery to pulmonary trunk. Using cardiopulmonary bypass with moderate systemic hypothermia, the mass was resected and the fistula was clipped with surgical clips. Pathology of the specimen was a giant coronary arterial aneurysm.

• Journal of Chest Surgery
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• v.26 no.3
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• pp.163-169
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• 1993

This is the result of the annual statistic analysis of thoracic and cardiovascular surgical cases in 1992 Korea. Overall 17, 520 cases of surgery [11, 732 cases of thoracic surgery by 54 institutes / 5, 788 cases of cardiovascular surgery by 48 institutes] were done. 1. Tumor [N=2, 532] : Lung was the most frequently involved organ by tumor [54.9%],and the remainders were mediastinum [16.2%] / esophagus [14.8%] / chest wall [11.7%] / tracheobronchus [1.3%] / pleura [1.1%] in order. Of 1, 082 cases of primary lung cancer surgery,the frequency of cell type was squamous [62.6%] / adeno [21.6%] / small cell [7.1%] / large cell [2.7%]. Of 411 cases of mediastinal tumor surgery,the frequency of cell type was neurogenic [28.8%] / thymoma [27.6%] / teratoma [17.7%] / congenital cystic [17.2%]. Of 376 cases of esophageal tumor surgery,primary cancer were the most [85.4%]. 2. Infection [N=3, 157] : Pleura was the most frequently involved organ [59.0%],and the remainders were lung [31.3%] / chest wall [8.6%] / mediastinum [1.1%] in order. 3. Miscellaneous [N=6, 043] : Lung and pleural disease esp. pneumothorax [85.1%] was the most frequent surgical indication. The remainders were chest wall anomaly [3.4%] / benign esophageal disease [3.4%] / diaphragmatic pathology [2.4%] / myasthenia [1.4%] in order. Of 85 cases of thymectomy for myasthenia gravis,thymoma was noted in 58.8%. 1. Congenital heart disease [N=3, 363] : The ratio of noncyanotic to cyanotic heart disease was 3:1. Of 2, 516 cases of noncyanotic heart disease,the frequency of disease entity was VSD [44.1%] / ASD [26.0%] / PDA [19.4%] / PS [3.3%],and that of 847 cases of cyanotic heart disease was TOF [29.4%] / ECD [15.6%] / TGA [9.7%] / DORV [7.6%]. Overall mortalities were 2.1% in noncyanotic and 12.2% in cyanotic heart surgery. 2. Acquired heart disease [N=1, 929] : Of 1, 422 cases of valvular surgery,single mitral pathology was the most frequent candidate [48.0%],and total 1, 574 prosthetic valves which were mainly mechanical [95.6%] were used. Of 376 cases of coronary surgery,triple vessel was the most [35.9%],and the frequency of bypassing grafts was great saphenous vein [52.9%] / internal mammary artery [44.7%] / artificial vessel [2.4%]. Overall mortalities were 3.4% in valvular and 4.5% in coronary surgery. 3. Pericardium,Cardiac tumor,Arrhythmia,Aortic aneurysm,Assist device,and Pacemaker : There were no specific changes compared to previous survey1]. This nation-wide inquiry will be continued and reported annually by KTCS Society.