• 한국CDE학회논문집
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• 제17권5호
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• pp.303-311
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• 2012

Laparoscopic surgery is a surgical procedure which uses long laparoscopic instruments through tiny holes in abdomen while watching images from a laparoscopic camera through umbilicus. Laparoscopic surgeries have many advantages rather than open surgeries, however it is hard to learn the surgical skills for laparoscopic surgery. Recently, some virtual simulation systems for laparoscopic surgery are developed to train novice surgeons or resident surgeons. In this study, we introduce the techniques that we developed for laparoscopic surgical training simulator for cholecystectomy (gallbladder removal), which is one of the most frequently performed by laparoscopic surgery. The techniques for cholecystectomy simulation include modeling of human organs (liver, gallbladder, bile ducts, etc.), real-time deformable body calculation, realistic 3D visualization of surgical scene, high-fidelity haptic rendering and haptic device technology, and so on. We propose each simulation technique for the laparoscopic cholecystectomy procedures such as identifying cystic duct and cystic artery to clamp and cut, dissecting connective tissues between the gallbladder and liver. In this paper, we describe the techniques and discuss about the results of the proposed cholecystectomy simulation for laparoscopic surgical training.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2011년도 춘계학술대회 논문집
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• pp.945-946
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• 2011

• Advances in pediatric surgery
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• 제19권2호
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• pp.90-97
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• 2013

Laparoscopic surgery has become popular in the past few decades, owing to less postoperative pain, fast recovery, and better cosmetic outcomes. The laparoscopic approach has been employed in pediatric surgery for the same reasons. After the first attempts of single incision laparoscopic appendectomy in pediatrics in 1998, single incision laparoscopic surgery (SILS) has recently been proven to be safe and feasible for the pediatric population. However, limitations have been reported for SILS, such as the wide learning curve, compared to standard laparoscopic surgery, and the restricted number of hospitals with surgical training programs including SILS. In this study, we intend to present our initial experiences with SILS in children, and to describe the technique, instruments used, and outcomes. This is a retrospective study of 71 pediatric patients who underwent SILS, at a tertiary medical center, between September, 2012 and August, 2013. Electronic medical records were reviewed for demographics, type of procedure, operation time, use of additional ports, conversion to open surgery, complications and hospital stay. Additional ports were inserted in 4 cases, for the purpose of traction. Postoperative complications were noted in 13 cases, which were mostly related to wound inflammation or formation of granulation tissue. According to our analyses, patients with complications had significantly longer use and more frequent use of pain killers. Notwithstanding the small sample size, many of the procedures performed in pediatric patients seem to be possible with SILS.

• Journal of Chest Surgery
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• 제46권4호
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• pp.293-294
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• 2013

Gastropleural fistula (GPF) is a rare condition that can occur as a consequence of prior pulmonary surgery, trauma, or malignancy. Conservative management usually fails, and gastrectomy and even thoracotomy is often required, especially in debilitated patients. We present a patient with GPF who had a history of Ewing's sarcoma. Diagnosis of GPF was confirmed by upper gastrointestinal system endoscopy and radiographic contrast examination, and the patient underwent a laparoscopic wedge resection of the fistula. To our knowledge, this is the first report of a GPF, in the formation of which recurrence of Ewing's sarcoma had played a role and in the treatment of which wedge resection of the fistula was performed. Laparoscopic treatment of GPF may be associated with less morbidity and should be considered as the initial procedure of choice.

• Journal of Gastric Cancer
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• 제24권1호
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• pp.57-68
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• 2024

Reduced-port gastrectomy (RPG) includes all procedures derived from various efforts to minimize surgical invasiveness, with single-incision laparoscopic gastrectomy (SILG) being the ultimate reduced-port technique. However, there are challenges related to its feasibility, oncological validity, training, and education. This review describes the current issues and challenges, as well as the future prospects of RPG for gastric cancer. Gastrectomy, which started as an open surgery, has evolved into a laparoscopic surgery. With the advancements in laparoscopic technology, SILG has been used to minimize surgical scarring. However, owing to the technical difficulties of SILG, cases involving the addition of 1 trocar or needle grasper alongside the multichannel port have also been reported. Additionally, 3-port laparoscopic gastrectomy (3PLG) using only 3 trocars is also being performed. RPG, as a concept, includes a range of approaches such as SILG, 2-port laparoscopic gastrectomy, and 3PLG. These techniques aimed to reduce the number of ports or incisions required for laparoscopic gastrectomy. Despite technical difficulties, RPGs offer numerous advantages, including minimal invasiveness, excellent cosmetic outcomes, and the potential for improved postoperative recovery, such as reduced length of hospital stay and post-operative pain. It could be considered similar to conventional laparoscopic gastrectomy, and may not be oncologically inferior. Ongoing studies, such as the KLASS 12, are required to gain further insights.

• 대한기계학회논문집A
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• 제35권8호
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• pp.883-888
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• 2011

복강경을 이용한 수술법은 입원 기간 단축 및 상처의 감소라는 장점이 있지만 수술 도구 끝단의 움직임의 제한으로 인한 수술 난이도의 증가라는 단점이 있다. 이를 숙련시키기 위해 동물을 이용하여 대체수술을 하거나, Surgery training tool set을 이용하여 조작 기술 습득을 위한 훈련을 하고 있다. 하지만 이 방법들은 사람에게서 느껴지는 촉감을 그대로 재현하지 못한다. 따라서 본 논문은 4-자유도계의 복강경 수술 의료 훈련 시뮬레이터를 통해 원활한 햅틱 피드백을 제공하였다. 햅틱 장비의 기본 요구조건인 무중력, 무마찰 상태를 만족시키기 위해 장비의 중력 및 마찰력을 측정하였다. 이를 위해 의료 시뮬레이터의 모델링을 하여 시술기에 작용하는 중력과 마찰력을 측정하고 이를 선형화 시킨후 이를 토대로 보상기를 모델링하고 이를 검증하였다.

• Archives of Plastic Surgery
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• 제41권3호
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• pp.201-208
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• 2014

Microsurgery is a precise surgical skill that requires an extensive training period and the supervision of expert instructors. The classical training schemes in microsurgery have started with multiday experimental courses on the rat model. These courses have offered a low threat supervised high fidelity laboratory setting in which students can steadily and rapidly progress. This simulated environment allows students to make and recognise mistakes in microsurgery techniques and thus shifts any related risks of the early training period from the operating room to the lab. To achieve a high level of skill acquisition before beginning clinical practice, students are trained on a comprehensive set of exercises the rat model can uniquely provide, with progressive complexity as competency improves. This paper presents the utility of the classical rat model in three of the earliest microsurgery training centres and the new prospects that this versatile and expansive training model offers.

• Journal of Digestive Cancer Research
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• 제5권1호
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• pp.28-31
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• 2017

The number of laparosocpic liver resection performed every years has been increasing. There is a trend than more major hepatectomy and complex liver resection is being reported. However there has been a major obstacles in many centers because open liver resection is still considered as a gold standard and many surgeons are still getting used to the old method of liver resection. To start a new procedure, education and training is essential in order to achieve a good outcome without compromising the safety of the patients. A gradual progression is crucial in order to avoid dreadful complication. The development of the consensus meeting and difficulty score has facility the understanding of safe practice in the development of laparoscopic liver resection. In a long run, development of registry system will improve transparency and safety of this operation.

• 대한전기학회:학술대회논문집
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• 대한전기학회 2008년도 학술대회 논문집 정보 및 제어부문
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• pp.68-70
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• 2008

Since the beginning of the 21st century, the emergence of innovative technologies made further advances in minimal access surgery possible. Robotic surgery and telepresence surgery effectively addressed the limitations of laparoscopic procedures, thus revolutionizing minimal access surgery. Surgical robots provide surgeons with to technologically advanced vision and hand skills. As a result, such systems are expected to revolutionize the field of surgery. In that time, much progress has been made in integrating robotic technologies with surgical instrumentation. However, robotic surgery will not only require special training, but it will also change the existing surgical training pattern and reshape the learning curve by offering new solutions, such as robotic surgical simulators and robotic telementoring. This article provides an introduction to medical robotic technologies, develops a possible classification, reviews the evolution of a surgical robot, and discusses future prospects for innovation. In the future, surgical robots should be smaller, less expensive, easier to operate, and should seamlessly integrate emerging technologies from a number of different fields. We believe that, in the near future as robotic technology continues to develop, almost all kinds of endoscopic surgery will be performed by this technology.

• Journal of Gastric Cancer
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• 제10권4호
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• pp.247-253
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• 2010

Purpose: Most stomach surgeons have been educated sufficiently in conventional open distal gastrectomy (ODG) but insufficiently in laparoscopy-assisted distal gastrectomy (LADG). We compared learning curves and clinical outcomes between ODG and LADG by a single surgeon who had sufficient education of ODG and insufficient education of LADG. Materials and Methods: ODG (90 patients, January through September, 2004) and LADG groups (90 patients, June 2006 to June 2007) were compared. The learning curve was assessed with the mean number of retrieved lymph nodes, operation time, and postoperative morbidity/mortality. Results: Mean operation time was 168.3 minutes for ODG and 183.6 minutes for LADG. The mean number of retrieved lymph nodes was 37.9. Up to about the 20th to 25th cases, the slope decrease in the learning curve for LADG was more apparent than for ODG, although they both reached plateaus after the 50th cases. The mean number of retrieved lymph nodes reached the overall mean after the 30th and 40th cases for ODG and LADG, respectively. For ODG, complications were evenly distributed throughout the subgroups, whereas for LADG, complications occurred in 10 (33.3%) of the first 30 cases. Conclusions: Compared with conventional ODG, LADG is feasible, in particular for a surgeon who has had much experience with conventional ODG, although LADG required more operative time, slightly more time to get adequately retrieved lymph nodes and more complications. However, there were more minor problems in the first 30 LADG than ODG cases. The unfavorable results for LADG can be overcome easily through an adequate training program for LADG.