• Clinical and Experimental Reproductive Medicine
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• 제25권3호
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• pp.341-348
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• 1998

Objective: To determine the reproductive outcomes of women undergoing microsurgical reversal of tubal sterilization at age 36 years or older. Materials and Methods: A series of 133 patients who received microsurgical reversal of the previously sterilized fallopian tubes at Seoul National University Hospital from July, 1980 to January, 1992 was reviewed and evaluated for clinical characteristics, pregnancy rates, and factors influencing the outcome of tubal reversal. Results: Of 133 patients, 78 (58.6%) had been sterilized by laparoscopic cautery. Loss of children was a leading cause for tubal reversal. The mean interval from tubal sterilization to tubal reversal was 65.0 months. The overall pregnancy rate was 52.6% (70/133), and the mean interval was 9.4 months from tubal reversal to pregnancy. Excluding 7 patients who were lost to follow-up, 76 pregnancies were confirmed in 63 patients with the delivery rate per patient of 66.7% (42/63). There were no significant differences in age, duration of tubal sterilization, postoperative tubal length between pregnant and non-pregnant groups. Conclusions: Microsurgical reversal of tubal sterilization could be a justifiable method in women 36 years age or older.

• Archives of Plastic Surgery
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• 제33권2호
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• pp.175-180
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• 2006

Preoperative angiography is frequently used in the planning of microsurgical reconstruction for identification of vascular abnormality that influence the planning of operation. But, recently 3D CT angiography is considered as new technique that can provide detailed information about vascular anatomy as well as soft and bony tissue without the risks of invasive angiography. 3D CT angiograms were performed in 19 patients before microsurgical reconstruction for the lower extremity and hand between May of 2003 and Oct of 2004. Sixteen of the studies were of the donor site and all of 19 studies were of the recipient site. No complications were found from the 3D CT angiograms. In one case of the bone exposed open wound, the injury of anterior tibial artery was identified and the zone of injury was adequately demonstrated. With the improvement in quality of CT imaging, 3D CT angiograms may provide a favorable alternative to invasive angiography. It is capable of providing high-resolution, three dimensional vascular imaging without the need for arterial puncture and prolonged post-procedure observation. The relation among blood vessels, bones, and soft tissue is well demonstrated in 3D CT angiogram. Also The acquisition time and examination cost were considerably lower in comparison with invasive angiography. In conclusion, this study demonstrates that 3D CT angiography may provide accurate, safe, and cost-effective preoperative imaging. The 3D CT angiography with relatively low morbidity, low cost, ease of image acquisition can have an broader role in microsurgical reconstructive surgery.

• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.740-750
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• 2021

Objective : Retrograde suction decompression (RSD) is an adjuvant technique used for the microsurgical treatment of large and giant internal carotid artery (ICA) aneurysms. In this study, we analyzed the efficacy and safety of the RSD technique for the treatment of large and giant ICA aneurysms relative to other conventional microsurgical techniques. Methods : The aneurysms were classified into two groups depending on whether the RSD method was used (21 in the RSD group vs. 43 in the non-RSD group). Baseline characteristics, details of the surgical procedure, angiographic outcomes, clinical outcomes, and procedure-related complications of each group were reviewed retrospectively. Results : There was no significant difference in the rates of complete neck-clipping between the RSD (57.1%) and non-RSD (67.4%) groups. Similarly, there was no difference in the rates of good clinical outcomes (modified Rankin Scale score, 0-2) between the RSD (85.7%) and non-RSD (81.4%) groups. Considering the initial functional status, 19 of 21 (90.5%) patients in the RSD group and 35 of 43 (81.4%) patients in the non-RSD group showed an improvement or no change in functional status, which did not reach statistical significance. Conclusion : In this study, the microsurgical treatment of large and giant intracranial ICA aneurysms using the RSD technique obtained competitive angiographic and clinical outcomes without increasing the risk of procedure-related complications. The RSD technique might be a useful technical option for the microsurgical treatment of large and giant intracranial ICA aneurysms.

• Archives of Plastic Surgery
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• 제50권6호
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• pp.627-634
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• 2023

In recent decades, a number of simulation models for microsurgical training have been published. The human placenta has received extensive validation in microneurosurgery and is a useful instrument to facilitate learning in microvascular repair techniques as an alternative to using live animals. This study uses a straightforward, step-by-step procedure for instructing the creation of simulators with dynamic flow to characterize the placental vascular tree and assess its relevance for plastic surgery departments. Measurements of the placental vasculature and morphological characterization of 18 placentas were made. After the model was used in a basic microsurgery training laboratory session, a survey was given to nine plastic surgery residents, two microsurgeons, and one hand surgeon. In all divisions, venous diameters were larger than arterial diameters, with minimum diameters of 0.8 and 0.6 mm, respectively. The majority of the participants considered that the model faithfully reproduces a real microsurgical scenario; the consistency of the vessels and their dissection are similar in in vivo tissue. Furthermore, all the participants considered that this model could improve their surgical technique and would propose it for microsurgical training. As some of the model's disadvantages, an abundantly thick adventitia, a thin tunica media, and higher adherence to the underlying tissue were identified. The color-perfused placenta is an excellent tool for microsurgical training in plastic surgery. It can faithfully reproduce a microsurgical scenario, offering an abundance of vasculature with varying sizes similar to tissue in vivo, enhancing technical proficiency, and lowering patient error.

• Korean Journal of Head & Neck Oncology
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• 제1권1호
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• pp.63-74
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• 1985

Although regional and myocutaneous flaps are still the standard in head and neck reconstruction. The capacity to transfer distant tissues by microsurgical technique expands the reconstructive surgeon's ability to restore severe deformities of the head and neck. From 1981 to 1985, thirteen patients with extensive defects of the head and neck after extirpative surgery of tumor have been reconstructed utilizing the technique of microsurgical composite tissue transplantation. In this series of patients, six presented with reconstructions in the different region of the head and neck with review of literatures. The results of case analysis are summarized as follows: 1) Transplantation was successful in twelve among thirteen patients (92%). 2) Seven patients presented with malignancy and six with benign tumor. 3) Frequent sites of reconstruction were face and mandible. 4) Fourteen free composite tissue transplantations for reconstruction of thirteen patients were obtained six different tissue compositions from eight different donor sites. 5) The recipient artery and vein was most often superficial temporal or facial vessels. 6) The average time of operation was ten hours.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.327-329
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• 2013

As a technically demanding skill, microsurgery is taught in the lab, in the form of a course of variable length (depending on the centre). Microsurgical training courses usually use a mixture of non-living and live animal simulation models. In the literature, a plethora of microsurgical training models have been described, ranging from low to high fidelity models. Given the high costs associated with live animal models, cheaper alternatives are coming into vogue. In this paper we describe the use of the chicken aorta as a simple and cost effective low fidelity microsurgical simulation model for training.

• Journal of Korean Neurosurgical Society
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• 제29권12호
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• pp.1677-1681
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• 2000

Microsurgical transthoracic extrapleural approach for thoracic discectomy in three cases were modified and simplified in order to achieve better exposure of ventral extradural space than posterolateral extrapleural(lateral extracavitary) approach and less pulmonary complications than transthoracic transpleural approach. These approaches were optimized by microscope and video-assistance. Surgery was followed by clinical improvement in all patients. The results of treatment seem to support the use of these modified techniques as adequate surgical treatment of thoracic disc herniations without any complications.

• Archives of Reconstructive Microsurgery
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• 제3권1호
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• pp.32-39
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• 1994

One hundred and sixty patients had reconstructive surgery of the lower extremity with the microsurgical technique at the department of orthopaedic surgery, Yonsei University College of Medicine from 1982 to 1989. There were ninty-six cases of men and sixty-four cases of women, in which the mean age was 23.8 years. These patients were followed for 21.4 months. The causes were 114 cases from traffic accidents, 18 cases from tumors, 12 cases from machinery injuries, 5 cases from burns, 2 cases from explosive injuries, and 9 cases from other reasons. There were 55 cases of scapular flap, 35 cases of groin flap, 23 cases of free vascularized osteocutaneous flap, 18 cases of parascapular flap, 9 cases of combined scapular and latissimus dorsi flaps, and 8 cases of segmental resection and rotationplasty. Success in reconstructive surgery with the microsurgical technique was achieved in one hundred and thirty four cases, and function and cosmetic results were excellent. Free vascularized flap with development of the microsurgical technique has taken an important role in reconstruction of large extremity defects where skin graft and distant flap were not applicable. Reconstruction of the lower extremity with the microsurgical technique is indicated with free vascularized osteocutaneous flap when there is a large defect of bone, a need for injured nerve replacement, and in the case of needed multiple staged operations. In these instences, this technique is regarded as simple one-staged reconstructive surgery.

• Journal of Chest Surgery
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• 제31권11호
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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.

• Journal of Korean Neurosurgical Society
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• 제30권5호
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• pp.600-604
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• 2001

Objective : The authors report the microsurgical anterolateral tunnel approach for the treatment of the cervical disc diseases and its postoperative surgical results. Methods : All surgical procedures followed the method of classical microsurgical anterior discectomy. Small tunnel(7-8mm) was made on the disc space reaching to the posterior longitudinal ligament. The disc materials and bony spurs were removed through this tunnel. Thirty-one patients of cervical disc herniation(24 cases with pure disc herniation, 7 cases with combined cervical spondylosis) were evaluated on the symptoms, conformation in plain X-ray, C-T, and MRI. The follow up time was over 2 years. Results : Postoperatively the result(following the out come scale) was excellent and good in Twenty-nine patients. One with fair result showed remnant disc particle and spur and another one is combined with cord contusion. One patient with lesion in C 3-4 space and two cervicothoracic junction showed excellent result. Two patients with osteoporosis also showed good results. Cervical spine curvature and disc space height were not changed on the plain X-ray and MRI in all patients. Twenty-nine patients were discharged within 3 days after surgery without any postoperative complications. Conclusions : The microsurgical anterolateral tunnel approach could be indicated for the treatment of patients with cervical disc diseases and with difficulty in achieving interbody fusion(the higher cervical level and cervicothoracic junction, osteoporosis etc.).