• 대한청각학회지
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• 제23권4호
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• pp.204-209
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• 2019

For a minimally invasive approach to access the facial nerve, we designed an extended epitympanotomy via a transmastoid approach that has proven useful in cases of traumatic facial nerve palsy and pre-cholesteatoma. To evaluate the surgical exposure through an extended epitympanotomy, six patients with traumatic facial nerve palsy were enrolled in this study. The same surgical technique was used in all patients. Patients were assessed and the degree of facial nerve paralysis was determined prior to surgery, 1-week post-operatively, and 6-months post-operatively using the House-Brackmann grading system. In all cases, surgical exposure was adequate. All patients with traumatic facial nerve palsy were male and the age range was 13 to 83 years. In all cases, the location of the facial nerve damage was limited to the area between the first and second genu. Symptoms of all the patients improved by 6 months post-operation (p=0.024). There were no complications in any of the patients. Extended epitympanotomy is useful for safe, rapid surgical exposure of the attic area, sparing the patient post-operative dimpling, skin incision complications, and lengthy exposure to anesthesia. We suggest that surgery for patients with facial nerve palsy secondary to trauma be performed using this described technique.

• 대한근전도전기진단의학회지
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• 제20권2호
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• pp.159-163
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• 2018

Guillain-Barre syndrome (GBS) after trauma and general orthopedic surgery is rare. A 74-year-old woman showed ascending paralysis symmetrically, dysarthria, dysphagia and areflexia on 14 days after minimally invasive endoscopic thermoannuloplasty on L4-5 level. Brain and lumbar magnetic resonance imaging demonstrate no abnormal findings. The electrodiagnostic study showed prolonged distal motor, sensory latencies and F-wave latencies and reduced amplitude of compound muscle action potential in nerves of upper and lower extremities. In the cerebrospinal fluid (CSF) examination, total protein and IgG were increased. We diagnosed Guillain-Barre Syndrome based on clinical features, electrodiagnostic study and CSF examination and the patient improved symptoms after immunoglobulin injection and rehabilitation. Because the occurrence of GBS after minimally invasive procedure has not been reported, we report a case of GBS after minimally invasive procedure with literature review.

• Journal of Chest Surgery
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• 제51권5호
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• pp.363-366
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• 2018

One of the complications of permanent pacemaker implantation is unintended phrenic nerve stimulation. A 15-year-old boy with a permanent pacemaker presented with chest discomfort due to synchronous chest wall contraction with pacing beats. Even after reprogramming of the pacemaker, diaphragmatic stimulation persisted. Therefore, we performed thoracoscopic phrenic nerve insulation using a Gore-Tex patch to insulate the phrenic nerve from the wire. A minimally invasive approach using a thoracoscope is a feasible option for retractable phrenic nerve stimulation after pacemaker implantation.

• 대한기계학회:학술대회논문집
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• 대한기계학회 2007년도 춘계학술대회A
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• pp.378-383
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• 2007

As the Minimally Invasive Surgery (MIS) is developed, an interventional procedure becomes the major of the spine surgery in the world. Despite of the use of the expensive medical equipments, the success chance of the nucleoplasty is about 30%. The reason is that the shape of the cannular needle is similar to that of the conventional injector and looks like the straight. Because the tip of these straight needles is not able to reach in the vicinity of the disc bulging or the protrusion, which are the cause of the low back pain and because the far indirect plasma discharge results in the decompression, the nucleoplasty has the limit. Many incurable diseases has not been solved due to the unexistence of the advanced technique for the MIS human body cannula device. If 3-D direction controllable cannular catheter (whose direction is accurately controlled after inserting into the bodies to cure the lesion) is developed, it is expected that new devised cannular catheter can cure many incurable diseases simultaneously. Therefore, the aims of this research are to develop the new devised cannular catheter of SMA direction controller for the medical situation, which has been produced through many previous trial-error procedures, and to produce the commercial medical device.

• The Korean Journal of Pain
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• 제27권4호
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• pp.313-320
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• 2014

Dexmedetomidine, an imidazoline compound, is a highly selective ${\alpha}_2$-adrenoceptor agonist with sympatholytic, sedative, amnestic, and analgesic properties. In order to minimize the patients' pain and anxiety during minimally invasive spine surgery (MISS) when compared to conventional surgery under general anesthesia, an adequate conscious sedation (CS) or monitored anesthetic care (MAC) should be provided. Commonly used intravenous sedatives and hypnotics, such as midazolam and propofol, are not suitable for operations in a prone position due to undesired respiratory depression. Dexmedetomidine converges on an endogenous non-rapid eye movement (NREM) sleep-promoting pathway to exert its sedative effects. The great merit of dexmedetomidine for CS or MAC is the ability of the operator to recognize nerve damage during percutaneous endoscopic lumbar discectomy, a representative MISS. However, there are 2 shortcomings for dexmedetomidine in MISS: hypotension/bradycardia and delayed emergence. Its hypotension/bradycardiac effects can be prevented by ketamine intraoperatively. Using atipamezole (an ${\alpha}_2$-adrenoceptor antagonist) might allow doctors to control the rate of recovery from procedural sedation in the future. MAC, with other analgesics such as ketorolac and opioids, creates ideal conditions for MISS. In conclusion, dexmedetomidine provides a favorable surgical condition in patients receiving MISS in a prone position due to its unique properties of conscious sedation followed by unconscious hypnosis with analgesia. However, no respiratory depression occurs based on the dexmedetomidine-related endogenous sleep pathways involves the inhibition of the locus coeruleus in the pons, which facilitates VLPO firing in the anterior hypothalamus.

• Journal of Chest Surgery
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• 제56권2호
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• pp.120-125
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• 2023

Background: Multiple rib fractures are common in blunt chest trauma. Until recently, most surgical rib fixations for multiple rib fractures were performed via open thoracotomy. However, due to the invasive nature of tissue dissection and the resulting large wound, an alternative endoscopic approach has emerged that minimizes the postoperative complications caused by the manipulation of injured tissue and lung during an open thoracotomy. Methods: Our study concentrated on patients with multiple rib fractures who underwent surgical stabilization of rib fractures (SSRF) between June 2018 and May 2020. We found 27 patients who underwent SSRF using video-assisted thoracoscopic surgery. The study design was a retrospective review of the patients' charts and surgical records. Results: No intraoperative events or procedure-related deaths occurred. Implant-related irritation occurred in 4 patients, and 1 death resulted from concomitant trauma. The average hospital stay was 30.2±20.1 days, and ventilators were used for 12 of the 22 patients admitted to the intensive care unit. None of the patients experienced major pulmonary complications such as pneumonia or acute respiratory distress syndrome. Conclusion: Minimally invasive rib stabilization surgery with the assistance of a thoracoscope is expected to become more widely used in patients with multiple rib fractures. This method will also assist patients in a quick recovery.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.371-374
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• 2014

Neurosurgeons have been trying to reduce surgical invasiveness by applying minimally invasive keyhole approaches. Therefore, this paper clarifies the detailed surgical technique, its limitations, proper indications, and contraindications for a superciliary keyhole approach as a minimally invasive modification of a pterional approach. Successful superciliary keyhole surgery for unruptured aneurysms requires an understanding of the limitations and the use of special surgical techniques. Essentially, this means the effective selection of surgical indications, usage of the appropriate surgical instruments with a tubular shaft, and refined surgical techniques, including straightforward access to the aneurysm, clean surgical dissection, and the application of clips with an appropriate configuration. A superciliary keyhole approach allows unruptured anterior circulation aneurysms to be clipped safely, rapidly, and less invasively on the basis of appropriate surgical indications.

• Journal of Korean Neurosurgical Society
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• 제42권3호
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• pp.195-199
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• 2007

Objective : Bilateral laminotomy and unilateral laminotomy for bilateral decompression are becoming the minimally invasive procedures for lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability. these techniques have been developed. But there are no large randomized studies to show the surgical results between these two techniques. The objective of this study was to examine the safety and efficacy of these two minimally invasive techniques. Methods : A total of 80 patients were included in this study (Group I : bilateral laminotomy, Group II : Unilateral laminotomy for bilateral decompression). Perioperative parameters and complications were analyzed. Symptoms and scores such as visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and SF-36 scores of prospectively accrued patients were assessed preoperatively and at 1 month and 12 months after surgery. Paired-t test, two-sample student-t tests, and non parametric tests were used to determine cross-sectional differences between two groups. Results : No major complications such as spinal instability or deaths occurred during follow-up periods. VAS, ODI scores and SF-36 body pain and physical function scores showed statistically significant improvements in both groups (p<0.001). The significant widening of the spinal canal diameter was also noted in both groups. But, in Group II. there were minor postoperative complications such as dural tear (2 cases 5.0%), fracture of ipsilateral inferior facet (1 case 2.5%), and 5 cases of transient leg symptoms of contralateral side. Conclusion : Both bilateral laminotomy and unilateral laminotomy for bilateral decompression allow achievement of adequate and long-lasting operative results in patients with LSS. But postoperative complications are more frequent in Group II (unilateral laminotomy and bilateral decompression). These results indicate that bilateral laminotomy is the preferred minimally invasive technique to treat symptomatic LSS.

• Journal of Chest Surgery
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• 제32권11호
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• pp.1009-1016
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• 1999

Background: Minimally invasive direct coronary artery bypass surgery(MIDCAB) has been increasing in interest along with the new techniques in myocardial immobilization for easier and safer procedures. Until the opening of the era of new techniques, adequate accuracy and good patency of grafts were debatable. Our experiences of MIDCAB were studied according to the stages of technical developments. Material and Methods: Since March 1996, 55 patients have undergone MIDCAB procedures. The patients of off-pump CABG(no cardiopulmonary bypass under full sternotomy) were excluded from the study. In the early experience(Stage I), a left anterior small thoracotomy through the left parasternal incision was performed(n=6); then an approach through the lower partial sternotomy was used(Stage II, n=33); and recently, a chest wall elevator for harvesting the internal thoracic artery and the foot plate for myocardial immobilization have been used(USSC, Norwalk, CT)(Stage III, n=16). Result: The surgical procedures of four patients in the Stage II group have been converted to conventional bypass because of the deeply seated left anterior descending coronary artery in two patients, fracture of the calcific lesion in the right coronary artery in one patient, and a cardiogenic shock during hypothermia in the other patient with ventricular dysfunction. Two patients in stage II experienced symptomatic recurrences after surgery and restenosis was verified on angiocardiography. They were managed by interventional procedures. All the other patients were doing well without symptoms, except one patients in Stage II who underwent PTCA procedure for a lesion in the circumflex artery during the follow up period. Conclusion: The new and specialized devices are essential to the development of MIDCAB surgery. MIDCAB and the hybrid procedures in multi-vessel disease are on the way to further development. So far, our experience is limited only to a single device among the many new devices for the purpose.

• Journal of Yeungnam Medical Science
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• 제41권2호
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• pp.96-102
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• 2024

Background: The aim of this study was to compare the early outcomes of octogenarians undergoing minimally invasive right anterior mini-thoracotomy aortic valve replacement (RAT-AVR) with those undergoing transcatheter aortic valve implantation (TAVI) for aortic valve disease. Methods: In this single-center retrospective study, data were collected from octogenarians before and after RAT-AVR and TAVI between January 2021 and July 2022. Short-term outcomes, including the length of hospital stay, in-hospital mortality, all-cause mortality, and other major postoperative complications, were compared and analyzed. Results: There were no significant differences in in-hospital mortality, stroke, acute kidney dysfunction requiring renal replacement therapy, length of intensive care unit stay, or length of hospital stay. However, the TAVI group had a higher incidence of permanent pacemaker insertion (10% vs. 0%, p=0.54) and paravalvular leaks (75% vs. 0%, p<0.001). Conclusion: In the present study on octogenarians, both TAVI and RAT-AVR showed comparable short-term results. Although both procedures were considered safe and effective in the selected group, RAT-AVR had a lower incidence of complete atrioventricular block and paravalvular regurgitation.