• 한국산학기술학회논문지
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• 제17권6호
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• pp.521-526
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• 2016

본 논문에서는 환자의 대장 내에서 자율적으로 이동이 가능한 자율주행 형 대장 내시경의 주행 메커니즘으로서 회전관성을 이용하여 환자의 장내 주행이 가능한 새로운 주행메커니즘의 설계 방법에 대해 제안한다. 상업용 대장 내시경은 시술할 때 환자에게 장시간의 고통과 불쾌감을 제공하여 환자들이 시술을 꺼리게 되어 내시경 검사가 필요한 대장 암 등의 조기 진단에 차질을 빚고 있다. 이 문제를 해결하기 위하여 환자의 장관 내에서 자율적으로 이동함으로써 불쾌감이나 고통을 줄일 수 있는 로봇 형 차세대 내시경에 대한 연구가 진행되어 왔다. 회전관성을 이용하는 주행 메커니즘에서는 회전관성을 일으키기 위하여 flywheel을 모터로 구동하여 에너지를 저장한다. flywheel에 의한 에너지 저장과 방출에 의하여 장내에서 로봇이 주행할 때 일어나는 stick-slip 현상을 효율적으로 극복할 수 있다. 이를 위해 flywheel의 속도제어가 가능하고 고주파 노이즈에 강건한 제어기를 설계하고 구현하였다. 여기서 제시하는 회전관성을 이용한 주행 메커니즘은 다른 메커니즘에 비해 구조가 간단할 뿐 아니라 주행도 효율적임을 실험을 통하여 증명하였다.

• 디지털융복합연구
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• 제19권6호
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• pp.393-398
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• 2021

사회가 복잡해지고 고도화 될수록 사고의 위험 또한 늘어날 수밖에 없고, 이는 선천적 장애 뿐 아니라 후천적 장애의 발생을 높이는 계기가 되고 있다. 이러한 상황에서 첨단기술의 복합체인 재활 로봇의 활용은 앞으로 꾸준히 늘어나게 될 전망이다. 이에 저자들은 국내·외 재활 로봇의 기술 동향과 향후 발전 전망에 대한 살펴보고자 한다. 지금까지의 장애 보조 로봇 기술은 보행 장애나 작업제한 장애 지원영역에서 주로 발전을 이루어왔다. 그러나 인구의 고령화는 인지장애 대상자가 늘어날 것이라는 점을 잠재하고 있기 때문에 사용자의 안전성을 확보한 장애 보조 로봇 개발이 추진되어야 하고, 이를 위해 다양한 형태의 임상연구를 통해 재활 로봇의 치료 효과에 대한 실증적 결과들이 도출, 융합되어야 할 것이라 생각된다.

• Journal of Gastric Cancer
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• 제16권2호
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• pp.63-71
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• 2016

Pylorus-preserving gastrectomy (PPG) is a function-preserving surgery for the treatment of early gastric cancer (EGC), aiming to decrease the complication rate and improve postoperative quality of life. According to the Japanese gastric cancer treatment guidelines, PPG can be performed for cT1N0M0 gastric cancer located in the middle-third of the stomach, at least 4.0 cm away from the pylorus. Although the length of the antral cuff gradually increased, from 1.5 cm during the initial use of the procedure to 3.0 cm currently, its optimal length still remains unclear. Standard procedures for the preservation of pyloric function, infra-pyloric vessels, and hepatic branch of the vagus nerve, make PPG technically more difficult and raise concerns about incomplete lymph node dissection. The short- and long-term oncological and survival outcomes of PPG were comparable to those for distal gastrectomy, but with several advantages such as a lower incidence of dumping syndrome, bile reflux, and gallstone formation, and improved nutritional status. Gastric stasis, a typical complication of PPG, can be effectively treated by balloon dilatation and stent insertion. Robot-assisted pylorus-preserving gastrectomy is feasible for EGC in the middle-third of the stomach in terms of the short-term clinical outcome. However, any benefits over laparoscopy-assisted PPG (LAPPG) from the patient's perspective have not yet been proven. An ongoing Korean multicenter randomized controlled trial (KLASS-04), which compares LAPPG and laparoscopy-assisted distal gastrectomy for EGC in the middle-third of the stomach, may provide more clear evidence about the advantages and oncologic safety of PPG.

• Journal of Chest Surgery
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• 제56권5호
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• pp.336-345
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• 2023

Background: The objective of this study was to demonstrate the safety, efficacy, and feasibility of intraoperative monitoring of the recurrent laryngeal nerves during thoracoscopic and robotic 3-field esophagectomy. Methods: This retrospective analysis details our initial experience using intraoperative nerve monitoring (IONM) during minimally invasive 3-field esophagectomy. Data were obtained from a prospectively maintained database and electronic medical records. The study included all patients who underwent minimally invasive (video-assisted thoracic surgery/robotic) transthoracic esophagectomy with neck anastomosis. The patients were divided into those who underwent IONM during the study period and a historical cohort who underwent 3-field esophagectomy without IONM at the same institution. Appropriate statistical tests were used to compare the 2 groups. Results: Twenty-four patients underwent nerve monitoring during minimally invasive 3-field esophagectomy. Of these, 15 patients underwent thoraco-laparoscopic operation, while 9 received a robot-assisted procedure. In the immediate postoperative period, 8 of 24 patients (33.3%) experienced vocal cord paralysis. Relative to a historical cohort from the same institution, who were treated with surgery without nerve monitoring in the preceding 5 years, a 26% reduction was observed in the nerve paralysis rate (p=0.08). On follow-up, 6 of the 8 patients with vocal cord paralysis reported a return to normal vocal function. Additionally, patients who underwent IONM exhibited a higher nodal yield and a decreased frequency of tracheostomy and bronchoscopy. Conclusion: The use of IONM during minimally invasive 3-field esophagectomy is safe and feasible. This technique has the potential to decrease the incidence of recurrent nerve palsy and increase nodal yield.

• 로봇학회논문지
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• 제9권1호
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• pp.48-56
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• 2014

In robotic surgery, a surgeon checks only a surgical site of patient in the progress of surgery by vision and sound information. In order to solve this limited information, the haptic function is necessary. And haptic surgical robot is also necessary to design a haptic master device. The master device for laparoscope operation with cable-conduit was developed in previous research to give haptic function. It suggested a possibility of developing a master device by using the cable-conduit. However, it is very inconvenient to use. Therefore, this paper suggests a new mechanism design structure to solve the problems of the previous work by new forming a new master device. And it has proved that it's usability is better than previous one. Furthermore it has also experimented and analyzed that a backlash of new master device is compensated by smooth backlash inverse algorithm.

• Journal of Yeungnam Medical Science
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• 제40권3호
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• pp.252-258
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• 2023

Background: The purpose of this study was to investigate whether postoperative cystography findings can predict early and longterm recovery from incontinence after radical prostatectomy (RP), compared with the other cystography parameters. Methods: I retrospectively reviewed 118 patients who underwent robot-assisted RP (RARP) for localized prostate cancer at single institution between January 2016 and April 2021. One hundred and seven patients were included in the study. Postoperative cystography was routinely performed 7 days after surgery. The bladder neck to pubic symphysis ratio, vesicourethral angle, and bladder neck anteroposterior length (BNAP) ratio (the bladder neck-posterior margin distances divided by the anteroposterior lengths) were evaluated. Continence was defined as cessation of pad use. The association between these variables and urinary incontinence was also analyzed. Results: The urinary incontinence recovery rates 1, 3, 6, and 12 months after RARP were 43.92%, 66.35%, 87.85%, and 97.19%, respectively. Multivariate logistic regression analysis demonstrated that a lower BNAP ratio and wider vesicourethral angle were significantly associated with continence restoration at 1, 3, and 6 months after surgery. In addition, in terms of days of pad usage, lower BNAP ratio, wider vesicourethral angle, and bladder neck preservation were significantly associated with recovery from urinary incontinence within 12 months as assessed by Cox proportional hazard analysis. Conclusion: This study demonstrated that vesicourethral angle and BNAP ratio were independent predictors of early recovery from post-prostatectomy incontinence. I suggest that both the sagittal and coronal views of postoperative cystography help anticipate early continence restoration after RARP.

• 한국간담췌외과학회지
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• 제27권2호
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• pp.211-216
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• 2023

It has been shown that external pancreatic ductal stenting (EPDS) can reduce the incidence of clinically relevant postoperative pancreatic fistula. Although studies have described EPDS in open pancreaticoduodenectomy (PD), EPDS in minimally invasive PD has not been reported yet. Thus, the objective of this study was to describe the technique of EPDS in minimally invasive PD. The procedure was performed either laparoscopically or using a robot. Once PD was completed, key steps included triple enterotomy, threading of silk-suture through all enterotomies and exteriorization, completing posterior layer of pancreaticojejunostomy (PJ), railroading stent through preplaced silk-suture, intubation of stent into the pancreatic duct, completion of PJ, followed by hepaticojejunostomy and parietalization of jejunum at the stent exit site. EPDS in PD through a minimally invasive approach can be performed safely in selected cases with either a small-sized pancreatic duct or a soft pancreas.

• Journal of Yeungnam Medical Science
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• 제41권1호
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• pp.48-52
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• 2024

While simultaneous bilateral partial nephrectomy with a conventional multiport robot has been consistently reported since the 2010s, the introduction of the DaVinci SP system (Intuitive Surgical, Sunnyvale, CA, USA) could provide a novel way to perform surgery on bilateral kidneys while innovatively reducing the number of incisions. In our first report worldwide, the patient with bilateral small renal mass (2.0 cm for the left and 1.5 cm for the right side) and preoperative normal renal function was placed in the lateral decubitus position on an inverted bed. After tilting the bed to be as horizontal as possible, a 4-cm incision was made in the lower part of the umbilicus for the floating trocar technique. The partial nephrectomy was performed reliably as with the conventional transperitoneal approach, and then the patient could be repositioned to the contralateral side for the same procedure, maintaining all trocars. Total operation time (skin to skin), total console time, and the left- and right-side warm ischemic times were 260, 164, 27, and 23 minutes, respectively, without applying the early declamping technique. The estimated blood loss was 200 mL. The serum creatinine right after the operation, on the first day, 3 days, and 90 days after surgery were 0.92, 0.77, 0.79, and 0.81 mg/dL, respectively. For 90 days after the procedure, no complications or radiologic recurrence were observed. Further clinical studies will reveal the advantages of using the DaVinci SP device for this procedure over traditional multiport surgery, maximizing the benefit of a single port-based approach.

• 로봇학회논문지
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• 제19권1호
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• pp.39-44
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• 2024

This study introduces a novel method for predicting the shape of soft catheter robots embedded with electromagnets. As an advancement in the realm of soft robotics, these catheter robots are crafted from flexible and pliable materials, ensuring enhanced safety and adaptability during interactions with human tissues. Given the pivotal role of catheters in minimally invasive surgeries (MIS), our design stands out by facilitating active control over the orientation and intensity of the inbuilt electromagnets. This ensures precise targeting and manipulation of the catheter segments. The research encompasses a comprehensive breakdown of the magnetic modeling, tracking algorithms, experimental layout, and analytical techniques. Both simulation and experimental results validate the efficacy of our method, underscoring its potential to augment accuracy in MIS and revolutionize healthcare-oriented soft robotics.

• 디지털융복합연구
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• 제19권2호
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• pp.523-529
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• 2021

의료서비스 로봇은 연구자 및 정부 관계부처들을 통해 다양하게 정의 및 분류되고 있으나 수술로봇과 재활로봇은 공통적으로 의료서비스 로봇에 포함되며, 이를 제외한 로봇은 기타 의료서비스 로봇으로 분류되고 있다. 본 연구에서는 기타 의료서비스 로봇 중 물류, 안내, 약제처리 로봇을 중심으로 국내·외 개발동향 및 활용사례 등을 고찰하였다. 물류로봇과 안내로봇은 국내에서 상당수 제품으로 개발되어 병원 등에서 시범사업을 완료했거나 상용화가 진행 중이며 수출도 하고 있으나 약제처리 로봇은 국내에서 개발된 제품이 있음에도 불구하고 병원에서 활용 중인 제품은 수입품이었다. 물류, 안내 및 약제처리 로봇은 생산인구의 감소 및 코로나19로 인한 비대면 수요 증가 등에 대응하기에 비교적 상용화가 용이하고 비용 효과적인 로봇이나 이러한 로봇에 대한 수요 예측 연구 등을 찾아보기 어려우므로 시장 확대와 활성화를 위해 체계적인 추후 연구가 필요하다.