• Journal of Chest Surgery
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• v.54 no.4
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• pp.263-265
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• 2021

Intraoperative events can occur during video-assisted thoracoscopic surgery (VATS) lobectomy due to unfavorable surgical anatomy, such as dense adhesions or calcifications around the pulmonary arteries. Troubleshooting intraoperative complications is essential for performing safe and successful VATS pulmonary resection and lymph node dissection. If continuous bleeding occurs or VATS does not proceed despite all measures, conversion to open thoracotomy should not be delayed.

• Journal of the Korean neurological association
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• v.36 no.4
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• pp.393-395
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• 2018

• Journal of the Korean neurological association
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• v.36 no.4
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• pp.405-407
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• 2018

• Korean Journal of Radiology
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• v.25 no.5
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• pp.501-503
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• 2024

• Journal of Chest Surgery
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• v.43 no.6
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• pp.729-733
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• 2010

Endovascular treatment of the aortic aneurysm with a stent graft is rapidly evolving. We describe here a case of hybrid TEVAR (thoracic endovascular aortic repair) in which the stent grafts were placed in the aortic arch after debranching of the arch vessels. The patient had undergone ascending aorta replacement for acute type I aortic dissection 2.5 years earlier. The aneurysmal change of the distal dissection progressed with time. A provisional bypass surgery from the ascending aorta to the innominate artery and left carotid artery was performed and then stent grafts were inserted via an antegrade route that covered the whole aortic arch and proximal descending thoracic aorta.

• Journal of Chest Surgery
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• v.53 no.5
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• pp.321-323
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• 2020

We describe the occurrence of acute type A aortic dissection in a patient with situs inversus totalis. A 37-year-old man presented to the emergency department with acute chest pain. Initial chest X-ray findings showed a right-sided heart and a left-sided liver. Contrast-enhanced computed tomography revealed a Stanford type A acute aortic dissection, aortic root dilatation, and situs inversus totalis. All of the thoracic structures were mirror-image reversed and an abnormal coronary artery was observed. The Bentall operation was performed. This report demonstrates that computed tomography and echocardiography were useful for understanding the anatomy and the presence or absence of concurrent anomalies in a patient with situs inversus totalis. The patient's postoperative course was uneventful.

• Journal of Gastric Cancer
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• v.20 no.3
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• pp.245-255
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• 2020

Purpose: Recently, non-exposure simple suturing endoscopic full-thickness resection (NESS-EFTR) was developed to prevent tumor exposure to the peritoneal cavity. This study aimed to evaluate the feasibility of NESS-EFTR with sentinel basin dissection for early gastric cancer (EGC). Materials and Methods: This was the prospective SENORITA 3 pilot. From July 2017 to January 2018, 20 patients with EGC smaller than 3 cm without an absolute indication for endoscopic submucosal dissection were enrolled. The sentinel basin was detected using Tc^99m-phytate and indocyanine green, and the NESS-EFTR procedure was performed when all sentinel basin nodes were tumor-free on frozen pathologic examination. We evaluated the complete resection and intraoperative perforation rates as well as the incidence of postoperative complications. Results: Among the 20 enrolled patients, one dropped out due to large tumor size, while another underwent conventional laparoscopic gastrectomy due to metastatic sentinel lymph nodes. All NESS-EFTR procedures were performed in 17 of the 18 other patients (94.4%) without conversion, and the complete resection rate was 83.3% (15/18). The intraoperative perforation rate was 27.8% (5/18), and endoscopic clipping or laparoscopic suturing or stapling was performed at the perforation site. There was one case of postoperative complications treated with endoscopic clipping; the others were discharged without any event. Conclusions: NESS-EFTR with sentinel basin dissection is a technically challenging procedure that obtains safe margins, prevents intraoperative perforation, and may be a treatment option for EGC after additional experience.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.329-338
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• 2017

Background: The clinical value of 3-field lymph node dissection (3FLND) in esophageal squamous cell carcinoma (ESCC) remains controversial. This study aimed to identify the patterns and prognostic significance of cervical lymph node metastasis (CLNM) in ESCC. Methods: A retrospective review of 77 patients with E SCC who underwent esophagectomy and 3FLND between 2002 and 2016 was conducted. For each cervical node level, the efficacy index (EI), overall survival, recurrence rate, and complication rate were compared. Results: CLNM was identified in 34 patients (44.2%) who underwent 3FLND. Patients with CLNM had a significantly lower overall survival rate (22.7% vs. 58.2%) and a higher recurrence rate (45.9% vs. 16.3%) than patients without CLNM. CLNM was an independent predictor of recurrence in ESCC patients. Moreover, in patients with pathologic N3 tumors, the odds ratio of CLNM was 10.8 (95% confidence interval, 2.0 to 57.5; p=0.005). Level IV dissection had the highest EI, and level IV metastasis was significantly correlated with overall survival (p=0.012) and recurrence (p=0.001). Conclusion: CLNM was a significant prognostic factor for ESCC patients and was more common among patients with advanced nodal stages. Level IV exhibited the highest risk of metastasis, and dissection at level IV may be crucial when performing 3FLND, especially in advanced nodal stage disease.

• Archives of Plastic Surgery
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• v.35 no.3
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• pp.283-288
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• 2008

Purpose: The purpose of this study is to evaluate the transverse cervical artery of those who received preoperative radiotherapy or radical neck dissection and those who are unable to utilize the branch of external carotid artery system, which are most commonly used as recipient artery in head and neck reconstruction. Methods: 10 patients were selected as head and neck cancer candidates for study. 8 patients received radical neck dissection or modified radical neck dissection and 3 patients underwent preoperative radiotheraphy. In call cases, reconstruction using free flap was performed with transverse cervical artery as recipient artery and posterolateral cervical vein or transverse cervical vein as recipient vein. Results: Partial necrosis of flap due to wound infection was noted in one case and successful microsurgery was achieved in all other cases. The average pedicle length was 9.3 cm and all arteries underwent end to-end anastomosis. In 7 patients, posterolateral cervical vein was used as recipient artery and transverse cervical vein was utilized in 3 patients. Conclusion: In cases where recipient artery from external carotid system cannot be utilized due to preoperative radiotherapy or radical neck dissection, the transverse cervical artery can be an alternative option of choice. Due to diverse variations of transverse cervical vein as a recipient vein, the posterolateral cervical vein may be considered in such cases.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1110-1115
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• 1998

Esophagectomy has a high morbidity rate, mainly related to pulmonary complications. The respiratory morbidity of open esophagectomy is high, ranging from 6% to 10%. This high morbidity is partially responsible for the 6∼15% mortality rate of esophagectomy. Many techniques of esophagectomy without thoracotomy have been described since the initial report of Orringer and Sloan. Endoscopic microsurgical dissection of the esophagus was clinically introduced in 1989. Endoscopic microsurgical dissection of the esophagus was developed as a minimally invasive procedure that avoids thoracotomy and provides precise vision during the operation in order to reduce mediastinal trauma and to improve the peri- and post-operative situation. A 20 year-old women who accidentally swallowed about 150 cc of glacial acetic acid underwent an esophagectomy using the operating mediastinoscopy, cervical esophagogastric anastomosis, pyloromyotomy, and feeding jejunostomy tube placement for esophageal stricture. The postoperative course was uneventful and the patient was discharged on the 17th postoperative day. Our clinical experience shows that endoscopic microsurgical dissection of esophagus is a safe and feasible method because it offers excellent optical control and enables the surgeon to operate in a minimally invasive manner.