• Journal of Chest Surgery
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• 제38권9호
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• pp.627-632
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• 2005

배경: 2mm 흉강경을 이용한 기흉의 수술은 정확성과 수술 후 재발률에 대한 신뢰가 부족한 실정이다. 원발성 자연기흉의 치료에서 2mm 흉강경과 10mm 흉강경의 수술 결과를 비교하였다. 대상 및 방법: 1998년 9원부터 2002년 12월 까지 고려대학교 안산병원에서 원발성 자연 기흉으로 기낭 정제술울 시행한 176예(10mm 흉강경 수술군 73예, 2mm 흉강경 수술군 103예)를 연구 대상으로 하였다. 10mm군은 10mm 흉강경, 5mm 포트를 통한 흉강경 기구, 2mm군은 2mm 포트를 통한 흉강경과 기구를 사용하였다. 결과: 두 군에서 추적 관찰기관은 10mm군이 20,8$\pm$16.1 개월, 2mm군은 13.9 $\pm$8.2개월 이였다. 수술 적응증은 10mm군에서는 재발성 기흉이 25예($34\%$), 2mm군에서는 환자가 원한 경우가 42예($40\%$)로 가장 많았다. 수술 시간, 사용한 자동 봉합기의 수, 술 후 흉관 거치일, 술 후 총 배액량, 술 후 재원일, 합병증 등에서 2mm군이 10mm군에 비하여 적었으며, 이 중 통계적으로 유의한 것은 수술 시간, 사용한 자동 봉합기의 수, 술 후 총 배액량, 술 후 재원일 등이었다. 수술 시간에 영향을 미치는 인자에 관한 회귀 분석에서 자동 봉합기의 사용개수, 늑막유착의 유무, 수술 시 늑막유착술 시행여부, 사용한 흉강경의 종류 등이 통계적으로 유의한 인자로 분석되었으나 $R^2$ 값은 모두 0.1 이하였다. 술 후 재발율은 10mm군에서는 총 73예 중 2예($2.7\%$), 2mm군에서는 총 103예 중 3예($2.9\%$)로 재발율의 차이는 통계적으로 유의성은 없었다. 재발율의 생명표 분석에서는 두 군 모두 수술후 1년 이내에 재발아였으며 재발률에 큰 차이가 없었다. 결론: 두 군 간에 추적 기간의 차이는 있었지만, 수술 시간, 사용한 자동 봉합기의 수, 술 후 총 배액량, 술 후 재원일에 있어서 2mm 흉강경군에서 의미있게 낮게 나타났다. 또한, 2mm 흉강경 사용 시, 좁은 시야에서도 불구하고 수술 중 기술적 어려움은 없었으며 술 후 재발률에도 10mm 흉강경과 차이는 없었다. 따라서 원발성 자연 기흉 환자의 수술방법으로 2mm 흉강경이 적용될 수 있으리라 생각된다.

• Journal of Chest Surgery
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• 제45권3호
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• pp.166-170
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• 2012

(VATS) lobectomy to junior surgeons, and to review the first year experience of a new surgeon performing VATS lobectomies who had not performed a VATS lobectomy unassisted during his training period. Materials and Methods: A young surgeon opened a division of general thoracic surgery at a medical institution. The surgeon had performed about 100 lobectomies via conventional thoracotomy during his training period, but had never performed a VATS lobectomy unassisted while under the supervision of an expert. After opening the division of general thoracic surgery, the surgeon performed a total of 38 pulmonary lobectomies for various pulmonary diseases from March 2009 to February 2010. All data were collected retrospectively. Results: There were 14 lobectomies via thoracotomy, 14 VATS lobectomies, and 10 cases of attempted VATS lobectomies that were converted to open thoracotomies. The number of VATS lobectomies increased from the second quarter (n=0) to the third quarter (n=5). The lobectomies that were converted from VATS into thoracotomies decreased from the second quarter (n=5) to the third quarter (n=1) (p=0.002). Conclusion: It can take 6 months for young surgeons without experience in VATS lobectomy in their training period to be able to reliably perform a VATS lobectomy.

• Journal of Chest Surgery
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• 제27권9호
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• pp.779-784
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• 1994

Vidio-assisted thoracic surgery[VATS] has recently evolved as an alternative to thoracotomy for several thoracic disorders,and the role of thoracoscopy has expanded with advances in surgical techniques and instruments. From May 1993 to May 1994, 13 patients with mediastinal mass underwent VATS for diagnosis and treatment at Gil General Hospital. There were four males and nine females, and their ages raged from 5 years to 66 years with average 38.8 years. Among 13 patients, 3 were operated for tissue diagnosis,9 for treatment,and 1 for diagnosis and treatment. Pathologic diagnoses were as follows; 5 benign neurogenic tumors, 2 thymoma, 2 sarcoidosis, 1 teratoma, 1 peripheral neuroepithelioma, 1 tbc lymphadenitis, and 1 pericardial cyst. The mean time of operation was 111.7 $\pm$ 30.7 minutes[60-160], mean duration of chest tube drainage was 2.9 $\pm$1.9days[1-9], mean hospital stay was 6.2 $\pm$2.6 days[4-13]. There was no patient needed blood transfusion or conversion to open thoracotomy. Accurate diagnosis was possible in all patients operated for diagnosis and /or treatment.[4/4,100%] Two complications occurred in two patients: 1 transient Horner,s syndrome,1 anhydrosis of left arm. Compared with those of conventional thoracotomy done for mediastinal mass during previous 2 years[May 1991 - April 1993], operative results of VATS were better in all aspects. For mediastinal mass, we concluded that VATS can be done with less morbidity,less complication,less blood loss,shorter operation time and hospital stay,and not more expensive in cost than conventional thoracotomy. Noticeably, we think that VATS is the operation of choice for the diagnosis and palliation of malignant mediastinal mass.

• Journal of Chest Surgery
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• 제27권3호
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• pp.226-229
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• 1994

VATS is now used by many thoracic surgeons and in various anatomic locations such as lung parenchyme, pleura and mediastinum, etc. VATS of mediastinal masses has special characteristics compared to that of other diseases. Those are no positional changes of the mass during collapse of the lung and close proximity of the mass to major vascular structures, nerves and other vital organs. From 1992. July to 1993. August, 10 mediastinal masses were treated with video assisted thoracoscopy. There were five males and five females, ages ranged from 11 years to 65 years with average 37.7 17.7 years old. Of the 10 patients, 4 were bronchogenic cysts, 2 were teratoma, and the others were thymoma, neurilemmoma, pericardial cyst, and thymic cyst. Needle aspiration was done in large cysts and the working thoracotomy[or utility thoracotomy] was done in large solid masses for the purpose of easy dissection, easy handling and easy delivery of the mass. The average operation time were 155.6 6.8 minutes and the duration of air leakage were 1 2.2 days. The duration of the chest tube drainage were 3.3 2.6 days. The lengths of the postoperative hospitalization were 5.1 2.7 days which were shorter than those of 12 mediastinal masses treated with conventional thoracotomy during the same periods [p<0.05]. There was 1 patient converted to thoracotomy because of a bleeding at innominate vein. 3 postoperative complications were occured. Those were persistent air leakage for 7 days, diaphragmatic palsy and hoarseness which were recovered within 1 month. We conclude that mediastinal mass can be excised with video assisted thoracoscopy and the posthospitalization is reduced. But careful attention is required for avoiding injury to major vascular structures, nerves, and other vital organs.

• Journal of Chest Surgery
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• 제27권3호
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• pp.221-225
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• 1994

Video-assisted thoracic surgery[VATS] has recently evolved as an alternative to thoracotomy for several thoracic disorders. Between March 1993 and September 1993, 42 patients underwent VATS at Gil General Hospital. They were diagnosed as spontaneous pneumothorax in 34[81.0%], mediastinal mass in 5, congenital lobar emphysema in 1, traumatic hemothorax in 1, and sarcoidosis in 1. For pneumothorax, wedge resection of bullae or blebs was done in 18 patients, wedge resection and limited parietal pleulectomy in 13, and only pleulectomy in 2. And excision for mediastinal mass in 5, hematoma evacuation for chronic hemothorax in 1, biopsies of mediastinal lymph node and lung for confirming sarcoidosis in 1, and lobectomy of left upper lobe for congenital lobar emphysema in the child of 12 years. The period of chest tube drainage and postoperative hospitalization averaged 3.8 days [range, 1 to 11 days] and 5.9 days [range, 2 to 18 days]. Three complications occurred in 3 patients with pneumothorax [7.1%, 2 recurrent pneumothorax and 1 postoperative bleeding], and the conversion to open thoracotomy was done in 1 due to massive air leak. The causes of postoperative air leak were speculated and the techniques for saving expensive Endo-GIA staplers are described in this paper. VATS is safe and offers the benefits of reduced postoperative pain and rapid recovery. Our experience indicates a markedly expanded role for VATS in the diagnosis and treatment of various thoracic diseases.

• Journal of Chest Surgery
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• 제33권10호
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• pp.812-816
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• 2000

Background ; To evaluate the efficacy of Fibrin glue to decrease recurrence in video-assisted thoracoscopic surgery(VATS) for a treatment of spontaneous penumothorax. Material and Method : All medical records of 17 patients who underwent a thoracoscopic wedge resections of bullae with stapling device with Fibrin glue in our institute between May 1998 and December 1999 were reviewed. variables analyzed include affected sites primary indication of VATS. duration from admission to discharge duration of postoperative stay duration of chest tube drainage recurrence and complication. There were 16 men and 1 woman. Result : There was no evidence of hemodynamic instability or arterial blood gas abnormalities encountered during the procedure. Mean age at the time of the VATS was 26.9 years (range 15 to 61 years) The mean duration from admission to discharge was 7.8 days and mean postoperative stay was 5.1days mean chest tube indwelling period was 4..0 days. There was no recurrence of pneumothorx. Conclusion : Thoracoscopic wedge resections with introduction of fibrin glue are safe and effective and requires only a short hospital stay. We believe that this thoracoscopic technique will further simplify the surgical treatment of pneumothorax.

• Journal of Chest Surgery
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• 제44권3호
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• pp.225-228
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• 2011

Background: Conventional treatment (i.e. chest tube insertion and chemical pleurodesis) still remains standard for patients with secondary spontaneous pneumothorax because the risk of surgical bullectomy is deemed high in this subset. However, it has been suggested that surgical treatment using thoracoscopy may expedite postoperative recovery and, thus, may reduce hospital stay. Materials and Methods: Retrospective review of 61 patients with secondary spontaneous pneumothorax, who underwent conventional treatment (n=39) or video-assisted thoracoscopic surgery (VATS) (n=22) between January 2007 and December 2009, was performed. Talc was used for chemical pleurodesis in both groups. Results: Hospital stay of conventional treatment group and VATS group was $14.2{\pm}14.2$ days (4~58 days) and $10.6{\pm}5.8$ days (5~32 days), respectively, with statistically significant difference (p=0.033). Recurrence rate of conventional treatment group was also significantly higher (12/39, 30%) compared to VATS group (1/22, 4.5%) (p=0.016). Conclusion: In selected patients with secondary spontaneous pneumothorax with continuous air leak or inadequate lung expansion, thoracoscopic surgery with chemical pleurodesis using talc results in shorter hospital stay and lower recurrence rate compared to conventional approach.

• Journal of Chest Surgery
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• 제31권4호
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• pp.369-373
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• 1998

대전을지병원 흉부외과에서는 1994년 1월부터 1997년 7월까지 자연성 기흉에서 비디오흉강경을 이용한 기포제거술 61례와 개흉술을 이용한 기포제거술 42례를 후향적으로 비교분석하여 두 집단사이에 수술시간은 개흉술이 98.3$\pm$38.4분, 비디오흉강경술이 95.7$\pm$31.5분으로 비슷하였으나 술후 재원기간은 개흉술에서 8.0$\pm$3.9일, 비디오흉강경에서 5.9$\pm$2.4일(P=0.001)이었으며, 술후 흉관삽관기간은 개흉술에서 5.8$\pm$3.0일, 비디오흉강경술에서 4.0$\pm$2.0일(P=0.0006)으로 의미가 있었으며, 합병증 발생에서는 비디오흉강경을 이용한 기포제거술에서 7일 이상 공기누출이 4례, 개흉술에서 8례로 만족할만한 결과를 얻었다.

• Journal of Chest Surgery
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• 제52권3호
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• pp.125-130
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• 2019

Background: To compare the outcomes of video-assisted thoracoscopic surgery (VATS) in comparison to open thoracic surgery in pediatric patients suffering from empyema. Methods: A prospective study was carried out in 80 patients referred to the Department of Pediatric Surgery between 2015 and 2018. The patients were randomly divided into thoracotomy and VATS groups (groups I and II, respectively). Forty patients were in the thoracotomy group (16 males [40%], 24 females [60%]; average age, $5.77{\pm}4.08years$) and 40 patients were in the VATS group (18 males [45%], 22 females [55%]; average age, $6.27{\pm}3.67years$). There were no significant differences in age (p=0.61) or sex (p=0.26). Routine preliminary workups for all patients were ordered, and the patients were followed up for 90 days at regular intervals. Results: The average length of hospital stay ($16.28{\pm}7.83days$ vs. $15.83{\pm}9.44days$, p=0.04) and the duration of treatment needed for pain relief (10 days vs. 5 days, p=0.004) were longer in the thoracotomy group than in the VATS group. Thoracotomy patients had surgical wound infections in 27.3% of cases, whereas no cases of infection were reported in the VATS group (p=0.04). Conclusion: Our results indicate that VATS was not only less invasive than thoracotomy, but also showed promising results, such as an earlier discharge from the hospital and fewer postoperative complications.

• Journal of Chest Surgery
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• 제47권2호
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• pp.189-192
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• 2014

Myelolipoma in the mediastinum is an extremely rare entity. In this report, we present the case of a 79-year-old asymptomatic man who had three bilateral paravertebral mediastinal tumors. The three tumors were resected simultaneously using bilateral three-port video-assisted thoracoscopic surgery (VATS). There has been no evidence of recurrence within four years after the operation. Multiple bilateral mediastinal myelolipomas are extremely rare. There are no reports in the English literature of multiple bilateral thoracic myelolipomas that were resected simultaneously using bilateral VATS. We also present characteristic features of myelolipomas, which are helpful for diagnosis.