• Journal of Chest Surgery
• /
• 제33권9호
• /
• pp.723-728
• /
• 2000

Background: Minimally invasive techniques for open heart surgery are widely accepted in these days. There are minimally invasive approaches by the right or left parasternal incision and another approaches by mini-sternotomy of upper or lower half or sternum. We report the safety and efficacy of minimally invasive technique with right parasternal incision compared with the routine full sternotomy. Material and Method: From April 1997 through February 1999, 20 patients(Group A) underwent minimally invasive cardiac operations. We chose 41 patients(Group B) whose preoperative diagnosis were the same and general conditions were similar and who underwent routine full sternotomy before April 1997. We compared A group and B group in many aspects. We performed routine full median sternotomy in B group but we did a minimally invasive technique through a small right parasternal incision in A group. Result: mean age was 36.1 years in both groups. In disease entities, there were 11 cases of ASD, 9 cases of mitral valve disease in group A, and 16 cases of ASD, 25 cases of mitral valve diseases in group B. In ASD, operation time, cardiopulmonary bypass time of aortic occulusion time were 263 min, 82 min, and 41 min in group A and 180 min, 53 min, and 32 min in group B. In mitral valve disease, operation time, cardiopulmonary bypass time and aortic occlusion time were 267min, 106 min, and 70min in A group and were 207 min, 82 min, and 69 min in group B. There were significant differences in operation time, CPB time, and ACC time between group A and group B. There was a significant difference in the amount of bleeding in postoperative day 1 between group A and group B of mitral diasease. However, there was no significant difference in the amount of bleeding in other comparisons. Mean length of incision was 8.7 cm in group A. There was no significant difference in postoperative complications between A group and B group. There was no mortality in either group. Conclusion: We conclude that this minimally invasive technique with right parasternal incision is cosmetically excellent but it is not effective in reducing operative time and there was no significant difference in recovery time and postoperative complications compared with routine full sternotomy.

• Clinics in Shoulder and Elbow
• /
• 제26권3호
• /
• pp.222-230
• /
• 2023

Background: Distal biceps tendon repairs are commonly performed using open techniques. A minimally invasive distal biceps tendon repair technique using a speculum and hooded endoscope was developed to improve visualization, reduce soft-tissue dissection, and minimize complications. This paper describes the technique and reports the outcomes of 75 minimally invasive distal biceps tendon repairs. Methods: The operation reports and outcomes of 75 patients who underwent distal biceps tendon repair using this technique between 2011 and 2021 were retrospectively reviewed. Results: Median time to follow-up was 12 months (interquartile range [IQR], 6-56 months). Primary outcomes were function as measured by the Disabilities of Arm, Shoulder and Hand Score (DASH) questionnaire, and rate of complications. Median DASH score was 1.7 of 100 (IQR, 0-6.8). There were 2 of 75 (2.7%) re-ruptures of the distal tendon. There were no cases of vascular injury, proximal radius fracture, or posterior interosseous nerve, median, or ulnar nerve palsy. Conclusions: In this series, minimally invasive distal biceps repair was safe and effective with a low rate of major complications. Recovery of function, as indicated by low DASH scores, was satisfactory, and inconvenience during recovery was minimized. Level of evidence: IV.

• 디지털융복합연구
• /
• 제17권7호
• /
• pp.265-274
• /
• 2019

본 연구는 로봇을 이용한 최소침습절개술 접근과 기존의 정중흉골절개술 접근을 이용한 심장판막수술환자를 대상으로 통증, 수면, 자가간호수행을 파악하고 이를 비교분석하기 위한 조사연구이다. 대상자는 서울시 일개 상급종합병원에서 심장수술을 시행한 대상자 중 정중흉골절개술군 64명, 최소침습절개술군 64명을 대상으로 하였다. 자료분석은 SPSS 22.0 프로그램을 이용하여 기술적 통계, ${\chi}^2$ 검증, paired t-test를 시행하였다. 수술 후 2일째, 5일째 모두 통증은 로봇을 이용한 최소침습절개술군이 정중흉골절개술군에 비해 높았다. 통증발생부위는 두 군 모두 수술접근부위로 크게 나타났다. 수면은 수술 후 2일째 정중흉골절개술군에서 높게 나타났으며, 자가간호수행은 최소침습절개술군에서 높게 나타났다. 그러므로 로봇 수술의 재원기간 단축과 빠른 회복 등의 장점에도 불구하고 대상자의 통증관리를 위해 정확한 통증 사정 및 차별화된 프로토콜의 적용이 필요시 된다. 또한 성별, 연령 및 수술방법의 차이를 고려하여 안위를 증진시키기 위한 체계화된 교육 프로그램 중재가 요구되어진다.

• 대한족부족관절학회지
• /
• 제14권1호
• /
• pp.73-78
• /
• 2010

Purpose: The purpose of this study is to analyze the clinical and radiological results of minimally invasive percutaneous screw fixation in intra-articular calcaneal fractures and its complications. Materials and Methods: This study is based on 30 intra-articular calcaneal fractures that treated by index operation from June 2005 to November 2006 with at least 6 months follow-up. We assessed the clinical and radiological outcomes and complications. Results: According to Sanders classification, there were 8 in type IIA, 7 in type IIB, 3 in type IIIAB, 6 in type IIIBC, 6 in type IV. And according to Essex-Lopresti classification, there were 9 in the tongue type, 21 in the joint depression type. Average follow-up period was 14.6 months (range: 6-23 months). Average interval between from injury to operation was 2.3 days. Average AOFAS score was 87.7 (range: 52-92). Satisfactory results were obtained in 22 cases (73.3%) by AOFAS score and in 20 cases (66.7%) by VAS score (mean: 3.4). Radiological results improved from 8.7 to 20.3 degrees in the Bohler angle and from 40.2 mm to 52.1 mm in calcaneal height. Postoperative complications were 2 skin and soft tissue problems and 1 sural neuropathy. Conclusion: Minimally invasive percutaneous screw fixation may be useful alternative surgical method in the management of Sanders type II and III calcaneal fractures, which is possible to achieves the anatomical restoration and minimizes postoperative complication in patients with high risks of soft tissue compromise and allows relatively early operation.

• Journal of Chest Surgery
• /
• 제55권1호
• /
• pp.98-100
• /
• 2022

Unilateral pulmonary edema after minimally invasive cardiac surgery is a rare, but potentially life-threatening condition. However, the exact causes of unilateral pulmonary edema remain unclear. We experienced aggressive unilateral pulmonary edema followed by redo-resection of recurrent left atrial myxoma through a right mini-thoracotomy. Intraoperative veno-venous extracorporeal membrane oxygenation was applied after the termination of cardiopulmonary bypass, and separate mechanical ventilation using a double-lumen endotracheal tube was applied after surgery. The patient was successfully treated and discharged uneventfully.

• Journal of Chest Surgery
• /
• 제49권2호
• /
• pp.92-98
• /
• 2016

Background: We used an Abramson technique for minimally invasive repair of pectus carinatum in patients who preferred surgery to brace therapy, had been unsuccessfully treated via brace therapy, or were unsuitable for brace therapy because of a rigid chest wall. Methods: Between July 2011 and May 2015, 16 patients with pectus carinatum underwent minimally invasive surgery. Results: The mean age of the patients was $24.35{\pm}13.20years$ (range, 14-57 years), and all patients were male. The percentage of excellent aesthetic results, as rated by the patients, was 37.5%, and the percentage of good results was 56.25%. The preoperative and postoperative Haller Index values were $2.01{\pm}0.19$ (range, 1.60-2.31), and $2.22{\pm}0.19$ (range, 1.87-2.50), respectively (p-value=0.01), and the median hospital stay was $7.09{\pm}2.91days$ (range, 5-15 days). Only one patient experienced postoperative complications. Conclusion: Minimally invasive repair is effective for the treatment of pectus carinatum, even in adult patients.

• Clinics in Shoulder and Elbow
• /
• 제18권2호
• /
• pp.75-79
• /
• 2015

Background: This retrospective comparative study aims to evaluate the surgical outcomes and complications of two surgical methods for simple fractures of the humeral shaft; minimally invasive anterior plating and open reduction combined with internal fixation. Methods: A total of 26 patients with humeral shaft simple fractures, who had surgery between June 2009 and September 2013 and were followed-up at least 12 months, were included in our analysis. They were divided into two groups; group 1 comprised of 12 patients who underwent minimally invasive anterior plating and group 2 comprised of 14 patients who underwent an open reduction and internal fixation. The clinical outcomes, radiological results, and complications were compared and analyzed. Results: We found that bone union was achieved in all patients, and the mean union periods were $20.7{\pm}3.34$ and $20.3{\pm}3.91$ weeks for groups 1 and 2, respectively. In most patients, we found that shoulder and elbow functions were recovered. At 12 months post-operation, we found that the Korean Shoulder Scoring system, the University of California at Los Angeles score and Mayo elbow performance score were $91.4{\pm}7.97$, $33.4{\pm}1.15$, and $90.8{\pm}2.23$ for group 1, and $95.2{\pm}1.53$, $33.3{\pm}1.43$, and $90.17{\pm}1.85$ for group 2. In terms of complications, we found that 2 patients had radial nerve palsy after open reduction and internal fixation, but all cases spontaneously resolved within 6 months. Complications such as infection and loss of fixation were not reported. Conclusions: Both minimally invasive anterior plating and open reduction with internal fixation produced satisfactory outcomes in the treatment of simple fractures of the humeral shaft.

• Journal of Chest Surgery
• /
• 제39권3호
• /
• pp.255-259
• /
• 2006

식도암의 수술은 일반적으로 개흉술과 개복술이 동시에 시행되며 경우에 따라 경부절개까지 추가되므로 다른 수술에 비해 이환율과 사망률이 상대적으로 높다. 수술에 따른 합병증을 최소화하고 빠른 회복을 유도하기 위하여 최근에는 양성 질환뿐만 아니라 악성 종양의 수술에도 저 침습적인 방법이 많이 시행되고 있으나, 식도암에는 적극적으로 적용되고 있지는 않으며 아직 국내보고도 없다. 최근 저자들은 8예의 식도암 환자에게 저 침습 수술을 적용하였기에 수술 기법을 중심으로 보고하는 바이다.

• Journal of Gastric Cancer
• /
• 제21권4호
• /
• pp.352-367
• /
• 2021

Purpose: Minimally invasive gastrectomy is a promising surgical method with well-known benefits, including reduced postoperative complications. However, for total gastrectomy of gastric cancers, this approach does not significantly reduce the risk of complications. Therefore, we aimed to evaluate the incidence and risk factors for the severity of complications associated with minimally invasive total gastrectomy for gastric cancer. Materials and Methods: The study included 392 consecutive patients with gastric cancer who underwent either laparoscopic or robotic total gastrectomy between 2011 and 2019. Clinicopathological and operative characteristics were assessed to determine the features related to postoperative complications after minimally invasive total gastrectomy. Binomial and multinomial logistic regression models were used to identify the risk factors for overall complications and mild and severe complications, respectively. Results: Of 103 (26.3%) patients experiencing complications, 66 (16.8%) and 37 (9.4%) developed mild and severe complications, respectively. On multivariate multinomial regression analysis, independent predictors of severe complications included obesity (OR, 2.56; 95% CI, 1.02-6.43; P=0.046), advanced stage (OR, 2.90; 95% CI, 1.13-7.43; P=0.026), and more intraoperative bleeding (OR, 1.04; 95% CI, 1.02-1.06; P=0.001). Operation time was the only independent risk factor for mild complications (OR, 1.06; 95% CI, 1.001-1.13; P=0.047). Conclusions: The risk factors for mild and severe complications were associated with surgery, indicating surgical difficulty. Surgeons should be aware of these potential risks that are related to the severity of complications so as to reduce surgery-related complications after minimally invasive total gastrectomy for gastric cancer.

• Journal of Chest Surgery
• /
• 제56권5호
• /
• pp.336-345
• /
• 2023

Background: The objective of this study was to demonstrate the safety, efficacy, and feasibility of intraoperative monitoring of the recurrent laryngeal nerves during thoracoscopic and robotic 3-field esophagectomy. Methods: This retrospective analysis details our initial experience using intraoperative nerve monitoring (IONM) during minimally invasive 3-field esophagectomy. Data were obtained from a prospectively maintained database and electronic medical records. The study included all patients who underwent minimally invasive (video-assisted thoracic surgery/robotic) transthoracic esophagectomy with neck anastomosis. The patients were divided into those who underwent IONM during the study period and a historical cohort who underwent 3-field esophagectomy without IONM at the same institution. Appropriate statistical tests were used to compare the 2 groups. Results: Twenty-four patients underwent nerve monitoring during minimally invasive 3-field esophagectomy. Of these, 15 patients underwent thoraco-laparoscopic operation, while 9 received a robot-assisted procedure. In the immediate postoperative period, 8 of 24 patients (33.3%) experienced vocal cord paralysis. Relative to a historical cohort from the same institution, who were treated with surgery without nerve monitoring in the preceding 5 years, a 26% reduction was observed in the nerve paralysis rate (p=0.08). On follow-up, 6 of the 8 patients with vocal cord paralysis reported a return to normal vocal function. Additionally, patients who underwent IONM exhibited a higher nodal yield and a decreased frequency of tracheostomy and bronchoscopy. Conclusion: The use of IONM during minimally invasive 3-field esophagectomy is safe and feasible. This technique has the potential to decrease the incidence of recurrent nerve palsy and increase nodal yield.