• Tuberculosis and Respiratory Diseases
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• 제40권5호
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• pp.468-473
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• 1993

연구배경 : 최근의 비디오 영상기술, 내시경 수술기구 및 내시경 수술기법의 눈부신 발달에 힘입어 흉강경의 영역이 단순한 늑막질환 진단에서 여러가지 흉부질환의 치료 방법으로 넓어졌다. 비디오 흉강경 수술(VATS) 방법은 3년전에 개발된 새롭고 가히 매력적이라 할 만한 흉부질환 수술방법으로 서울대학교병원에서도 1992년 7월에 도입하여서 비록 짧은 기간이지만 여러가지 임상경험을 하였기에 그 결과를 분석한다. 방법 : 1992년 7월부터 1993년 4월까지 10개월간 30명 환자에게 31예의 비디오 흉강경 수술을 시행하였다. 폐기포 절제술이 18명(19예), 종격동 종양 절제술이 4예, 폐실질 폐조직 생검 3예, 늑막생검 3예, 늑막종괴제거술 1예 그리고 늑막심낭창형성술 1예였다. 결과 : 사망예는 없으며 8예의 합병증이 발생하였다. 장기간공기누출이 3예, 장기간 늑막액 유출이 2예, 기흉재발 1예, 호너씨 증후군 1예, 애성 1예였다. 31예 모두 비디오흉강경 자체로 수술을 완료하였다. 합병증이 없었던 자연기흉 환자들의 술후 입원기간은 5일정도로 평상적인 개흉술로 수술받은 환자보다 입원기간이 약간 짧았다. 결론 : 비록 비디오 흉강경 수술은 초기단계라서 비교적 술후 합병증 빈도가 높았지만 이러한 술식이 통증감소, 입원기간단축, 빠른 회복, 미용적으로 우수한 작은 수술 상처 등의 여러가지 장점을 갖고 있어 환자들에게 매우 유익하다고 확신한다. 비디오 흉강경수술의 영역은 앞으로 흉곽내 여러가지 질환의 진단과 치료에 사용되고 심지어 심장병질환에도 응용될 것이라 생각된다.

• Journal of Chest Surgery
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• 제50권4호
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• pp.275-280
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• 2017

Background: Video-assisted thoracoscopic surgery (VATS) anatomic lung resections are gradually becoming the standard surgical approach in early-stage non-small cell lung cancer (NSCLC). The technique is being applied in cases of larger tumors depending on the experience of the surgical team. The objective of this study was to compare early surgical and survival outcomes in patients undergoing anatomic pulmonary resections using VATS and thoracotomy techniques for clinical T2 NSCLC during the adaptation period of the surgical team to the VATS approach. Methods: The data of all patients who underwent anatomic pulmonary resection for NSCLC using VATS and open techniques since April 2012 were recorded to create a prospective lung cancer database. Clinical T2 NSCLC patients who underwent VATS anatomic lung resection were identified and compared with cT2 patients who underwent open resection. Results: Between April 2012 and August 2014, 269 anatomical resections for NSCLC were performed (80 VATS and 189 thoracotomy). Thirty-four VATS patients who had clinical T2 disease were identified and stage-matched to thoracotomy patients. The average tumor diameter was comparable ($34.2{\pm}11.1{\times}29.8{\pm}10.1mm$ vs. $32.3{\pm}9.8{\times}32.5{\pm}12.2mm$, p=0.4). Major complications were higher in the thoracotomy group (n=0 vs. n=5, p=0.053). There was no 30-day mortality, and the 2-year survival rate was 91% for VATS and 82% for thoracotomy patients (p=0.4). Conclusion: VATS anatomic resections in clinical T2 NSCLC tumors are safe and have perioperative and pathologic outcomes similar to those of thoracotomy, while remaining within the learning curve.

• Journal of Chest Surgery
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• 제45권1호
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• pp.35-39
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• 2012

Background: The aims of the study were to determine the accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting pulmonary metastasis through video-assisted thoracoscopic surgery (VATS), a technique that allows the excisional biopsy of small pulmonary nodules in patients with known malignancies. Materials and Methods: Between October 2007 and April 2010, 28 patients with known malignancies and small pulmonary nodules underwent VATS excisional biopsies. All patients were in follow-up for a previously treated malignancy. The malignancies included the following: colorectum (9), breast (6), head and neck (5), stomach (3), lymph (1), ovary (1), uterus (1), bladder (1), and liver (1). Results: There were 16 men and 12 women whose mean age was 56.7 years old (range, 38 to 77 years). The sizes of the mean nodules removed were 11.3 mm (range, 7 to 21 mm). Diagnoses included metastatic (11), bronchioloalveolar carcinoma (1), primary adenocarcinoma (1), pulmonary tuberculosis (6), fibrosis (5), organizing pneumonia (3), lymphoid hyperplasia (1). Among these lesions, 46.4% were malignant. Conclusion: True positive FDG-PET was 39.2%. FDG-PET is not a sensitive test in the evaluation of patients with a history of an extrathoracic malignancy and newly diagnosed small pulmonary nodules. VATS excision allows the early diagnosis of small pulmonary nodules, with low morbidity, in patients with known malignancies.

• Journal of Chest Surgery
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• 제57권3호
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• pp.302-311
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• 2024

Background: Unexpected conversion to thoracotomy during planned video-assisted thoracoscopic surgery (VATS) can lead to poor outcomes and comparatively high morbidity. This study was conducted to assess preoperative risk factors associated with unexpected thoracotomy conversion and to develop a risk scoring model for preoperative use, aimed at identifying patients with an elevated risk of conversion. Methods: A retrospective analysis was conducted of 1,506 patients who underwent surgical resection for non-small cell lung cancer. To evaluate the risk factors, univariate analysis and logistic regression were performed. A risk scoring model was established to predict unexpected thoracotomy conversion during VATS of the lung, based on preoperative factors. To validate the model, an additional cohort of 878 patients was analyzed. Results: Among the potentially significant clinical variables, male sex, previous ipsilateral lung surgery, preoperative detection of calcified lymph nodes, and clinical T stage were identified as independent risk factors for unplanned conversion to thoracotomy. A 6-point risk scoring model was developed to predict conversion based on the assessed risk, with patients categorized into 4 groups. The results indicated an area under the receiver operating characteristic curve of 0.747, with a sensitivity of 80.5%, specificity of 56.4%, positive predictive value of 1.8%, and negative predictive value of 91.0%. When applied to the validation cohort, the model exhibited good predictive accuracy. Conclusion: We successfully developed and validated a risk scoring model for preoperative use that can predict the likelihood of unplanned conversion to thoracotomy during VATS of the lung.

• 대한기관식도과학회지
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• 제13권1호
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• pp.39-42
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• 2007

Esophageal duplication cyst is very rare mediastinal tumor which is congenital lesion of the esophagus. Esophageal duplication cyst could be excised with video assisted thoracoscopic surgery(VATS) if it is relatively small, cystic lesion and not adhered severely to the surrounding tissues such as lung, trachea, bronchus, esophagus and pleura. We report a case of an esophageal duplication cyst which was located in the right thoracic cavity below carina and could be excised completely and repaired by interrupted suture with 3.0 black silk. The patient was discharged at 10 days after operation with good condition and has been in uneventful condition 2 months after operation.

• Journal of Chest Surgery
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• 제50권3호
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• pp.184-189
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• 2017

Background: The benefits of video-assisted thoracoscopic surgery (VATS) have been demonstrated over the past decades; as a result, VATS has become the gold-standard treatment for primary spontaneous pneumothorax (PSP). Due to improvements in surgical technique and equipment, single-port VATS (s-VATS) is emerging as an alternative approach to conventional three-port VATS (t-VATS). The aim of this study was to evaluate s-VATS as a treatment for PSP by comparing operative outcomes and recurrence rates for s-VATS versus t-VATS. Methods: Between March 2013 and December 2015, VATS for PSP was performed in 146 patients in Kyungpook National University Hospital. We retrospectively reviewed the medical records of these patients. Results: The mean follow-up duration was $13.4{\pm}6.5$ months in the s-VATS group and $28.7{\pm}3.9$ months in the t-VATS group. Operative time (p<0.001), the number of staples used for the operation (p=0.001), duration of drainage (p=0.001), and duration of the postoperative stay (p<0.001) were significantly lower in the s-VATS group than in the t-VATS group. There was no difference in the overall recurrence-free survival rate between the s-VATS and t-VATS groups. Conclusion: No significant differences in operative outcomes and recurrence rates were found between s-VATS and t-VATS for PSP. Therefore, we cautiously suggest that s-VATS may be an appropriate alternative to t-VATS in the treatment of PSP.

• Journal of Trauma and Injury
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• 제30권2호
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• pp.55-58
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• 2017

Standard open procedures for resection of the first rib in thoracic outlet syndrome can prove to be quite difficult with extensive incisions. A minimal invasive procedure can also be painstaking, but provides an attractive alternative to the more radical open procedures. We report the details of the technique with direct video footage of the procedure performed in a 41-year-old man with thoracic outlet syndrome done entirely by thoracoscopic methods.

• 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.

• 대한기관식도과학회지
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• 제17권2호
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• pp.92-97
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• 2011

MMinimally invasive surgery (MIS) for early stage lung cancer has been an important treatment modality. However, the ergonomic discomfort and counterintuitive instruments hindered the application of video-assisted thoracic surgery (VATS) to more advanced procedures. To improve the compliance with MIS, robotic surgery was adopted. This advance aimed to alleviate the shortcomings of VATS by maximizing the comfort of the surgeon while providing instruments that enabled technically demanding operations and three-dimensional views with increased freedom for intrathoracic movement owing to EndoWrist$^{(R)}$. In this session, we introduced the clinical applications and its results of robot-assisted thoracic surgery in the field of lung cancer surgery. In conclusion, robot-assisted pulmonary resection with lymph node dissection for lung cancer is safe as well as feasible, and it results in a satisfying postoperative outcome. Robot-assisted surgery may provide a good alternative to conventional open or thoracoscopic surgery for lung cancer, provided that the cost effectiveness and long-term prognosis are confirmed.

• Journal of Chest Surgery
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• 제53권5호
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• pp.313-316
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• 2020

Esophageal perforation after endoscopic ultrasound-guided fine-needle aspiration for mediastinal staging is a rare but severe complication. We report 2 cases of patients with esophageal perforation who were treated using video-assisted thoracoscopic surgery in combination with esophageal stenting. Through these cases, the feasibility of minimally invasive thoracic surgery was evaluated.