• 보건의료기술평가
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• 제6권2호
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• pp.142-147
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• 2018

Objectives: The purpose of this study is to evaluate the safety and effectiveness of Robot-Assisted Brain Stereotactic Surgery with a systematic review. Methods: Electronic literature was searched using KoreaMed, Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library on 6th April 2017. Two authors screened 1218 citations. Duplicated articles of 456 excluded, the remaining 762 articles were reviewed with title and abstract. Results: A total of 8 studies were selected in this review. The device used in all studies was $ROSA^{TM}$. In one cohort study comparing the intervention ($ROSA^{TM}$) with the control (conventional stereotactic surgery), hematoma was reported no significant difference between groups. In six descriptive studies, one study reported hematoma 10% (10/100) and temporary nerve impairment 6% (6/100) using the ROSA; while five descriptive study did not report any complications. In one cohort, the localization precision were 1.2 mm in the intervention group and 1.1 mm in the control group; the localization success rate as 78.2% in the intervention group and 76.2% in the control group in one cohort; and the average time for surgery as 130 min for the intervention group and 352 min for the control group in one cohort. Four studies reported the localization success rate as 100%; two out of three articles reported the overall time for surgery as 56 min and 90 min, while one article reported the time as less than one hour in 50% of patients (50/100); two articles reported in epilepsy patients, the condition after the surgery was Engel level I in 66.2%, 75% patients, Engel level II-III in 25%, 26.5% patients, and Engel level 4 in 7.3% patients. Conclusion: Robot-Assisted Brain Stereotactic Surgery is a safe and accurate technique that can significantly reduce the time for the brain stereotactic surgery. However, further studies are needed to generalize the results.

• Journal of Gastric Cancer
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• 제24권4호
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• pp.356-366
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• 2024

Purpose: The usability of a new surgical navigation system that provides patient-specific vascular information for robotic gastrectomy in gastric cancer remains unexplored for laparoscopic gastrectomy owing to differences in surgical environments. This study aimed to evaluate the applicability and safety of this navigation system in laparoscopic gastrectomy and to compare the post-operative outcomes between procedures with and without its use. Materials and Methods: Between June 2022 and July 2023, 38 patients across 2 institutions underwent laparoscopic gastrectomy using a navigation system (navigation group). The technical feasibility, safety, and accuracy of detecting variations in vascular anatomy were measured. The perioperative outcomes were compared with 114 patients who underwent laparoscopic gastrectomy without a navigation system (non-navigation group) using 1:3 propensity score matching during the same study period. Results: In all patients in the navigation group, no adverse events associated with the navigation system occurred during surgery in any patient in the navigation group. No accidental vessel injuries necessitate auxiliary procedures. All vessels encountered during the gastrectomy were successfully reconstructed and visualized. Patient demographics and operative data were comparable between the 2 groups. The navigation group exhibited a significantly lower overall complication rate (10.5%) than the non-navigation group (26.3%, P=0.043). Notably, pancreas-related complications were absent in the navigation group but occurred in eight cases in the non-navigation group (7.0%, P=0.093), although the difference was not statistically significant. Conclusions: The patient-specific surgical navigation system demonstrated clinical feasibility and safety for laparoscopic gastrectomy for gastric cancer, potentially reducing complication rates compared with laparoscopic gastrectomy without its use.

• Journal of Gastric Cancer
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• 제21권4호
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• pp.352-367
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• 2021

Purpose: Minimally invasive gastrectomy is a promising surgical method with well-known benefits, including reduced postoperative complications. However, for total gastrectomy of gastric cancers, this approach does not significantly reduce the risk of complications. Therefore, we aimed to evaluate the incidence and risk factors for the severity of complications associated with minimally invasive total gastrectomy for gastric cancer. Materials and Methods: The study included 392 consecutive patients with gastric cancer who underwent either laparoscopic or robotic total gastrectomy between 2011 and 2019. Clinicopathological and operative characteristics were assessed to determine the features related to postoperative complications after minimally invasive total gastrectomy. Binomial and multinomial logistic regression models were used to identify the risk factors for overall complications and mild and severe complications, respectively. Results: Of 103 (26.3%) patients experiencing complications, 66 (16.8%) and 37 (9.4%) developed mild and severe complications, respectively. On multivariate multinomial regression analysis, independent predictors of severe complications included obesity (OR, 2.56; 95% CI, 1.02-6.43; P=0.046), advanced stage (OR, 2.90; 95% CI, 1.13-7.43; P=0.026), and more intraoperative bleeding (OR, 1.04; 95% CI, 1.02-1.06; P=0.001). Operation time was the only independent risk factor for mild complications (OR, 1.06; 95% CI, 1.001-1.13; P=0.047). Conclusions: The risk factors for mild and severe complications were associated with surgery, indicating surgical difficulty. Surgeons should be aware of these potential risks that are related to the severity of complications so as to reduce surgery-related complications after minimally invasive total gastrectomy for gastric cancer.

• International journal of thyroidology
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• 제11권2호
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• pp.109-116
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• 2018

갑상선 수술 후 발생한 성대마비는 삶의 질을 중요시하는 요즘 시대에 제일 치명적 합병증 중 하나이다. 그 결과 수술 중 신경감시시스템의 사용은 보편화되고 있으나 아직 기존의 시스템은 외과 의사가 사용하기에 불편하거나 문제점들이 있다. 그래서 새로운 방식의 신경 탐침과 신경 감시 장치의 개발이 필요한 시점이다. 이에 최근 모든 수술 기구(금속형 기구, 내시경 및 로봇 기구, 에너지 기반 디바이스)에 탈부착이 가능한 신경을 자극하는 신경 탐침 및 후두 떨림을 측정하기 위한 표면압력센서를 이용한 새로운 형태의 수술 중 신경감시시스템의 개발에 대한 연구가 기대된다.

• Hip & pelvis
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• 제36권1호
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• pp.26-36
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• 2024

Total hip arthroplasty (THA) is a frequently performed procedure; the objective is restoration of native hip biomechanics and achieving functional range of motion (ROM) through precise positioning of the prosthetic components. Advanced three-dimensional (3D) imaging and computed tomography (CT)-based navigation are valuable tools in both the preoperative planning and intraoperative execution. The aim of this study is to provide a thorough overview on the applications of CT scans in both the preoperative and intraoperative settings of primary THA. Preoperative planning using CT-based 3D imaging enables greater accuracy in prediction of implant sizes, leading to enhancement of surgical workflow with optimization of implant inventory. Surgeons can perform a more thorough assessment of posterior and anterior acetabular wall coverage, acetabular osteophytes, anatomical landmarks, and thus achieve more functional implant positioning. Intraoperative CT-based navigation can facilitate precise execution of the preoperative plan, to attain optimal positioning of the prosthetic components to avoid impingement. Medial reaming can be minimized preserving native bone stock, which can enable restoration of femoral, acetabular, and combined offsets. In addition, it is associated with greater accuracy in leg length adjustment, a critical factor in patients' postoperative satisfaction. Despite the higher costs and radiation exposure, which currently limits its widespread adoption, it offers many benefits, and the increasing interest in robotic surgery has facilitated its integration into routine practice. Conducting additional research on ultra-low-dose CT scans and examining the potential for translation of 3D imaging into improved clinical outcomes will be necessary to warrant its expanded application.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권1호
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• pp.65-68
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• 2004

CyberKnife is a stereotactic radiosurgery system which could be used to treat many tumors and lesions. It provides the surgeon unparalleled flexibility in targeting using a compact light linear accelerator mounted on a robotic arm. Advanced image guidance technology tracks patient and target position during treatment, ensuring accuracy without the use of an invasive head frame. CyberKnife with Dynamic Tracking Software is cleared to provide radiosurgery for lesions anywhere in the body when radiation treatment is indicated. It has often been used to radiosurgically treat otherwise untreatable tumors and malformations. Moreover, this instrument treats tumors at body sites, most of which are unreachable by other stereotactic systems. Compared with conventional radiotherapy, it is fundamentally different that using non-invasive, frameless, no excessive radiation exposure to normal tissue. In oral malignant neoplasm, surgical excision and radiation therapy should be tried first, additionally chemotherapy could be considered. However, after failure of conventional therapies, patients had poor systemic condition and surgical limitation. So, CyberKnife could be a suitable therapy. A 49 years man was referred in recurred mandibular cancer treated by radiotherapy. The tumor was considered inoperable, because of extensive invasion and was not expected to good response to conventional therapies. We experienced a case of CyberKnife after 4 cycle chemotherapies, so we report it with review of literature.

• 대한두경부종양학회지
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• 제30권1호
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• pp.10-14
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• 2014

목 적 CO2 가스 삽입 없이 내시경 보조 갑상선 절제술, 특히 액와 절개를 이용하는 경우의 대부분은 기구 사용을 용이하게 하기 위하여 흉부 또는 유륜에 절개를 넣어 시행하는 것이 대부분이다. 본 연구는 후이개 절개를 통하여 추가적 절개 없이 내시경을 이용한 갑상선 절제술 및 중심 임파선 절제술이 가능한지의 여부를 사체연구를 통하여 확인해 보고자 한다. 방 법 사체 이용 해부 및 수술 후이개 내시경 보조 갑상선 절제술이 가능한지의 확인은 수술 시야 및 접근성, 수술 완성도, 그리고 주요 구조물의 보존 여부인 3가지 항목으로 평가하였다. 결 과 수술 시야는 기구를 다루고 수술을 하기에 충분하였으며, 추가 절개 없이 수술을 완성할 수 있었다. 절제된 갑상선 조직의 피막은 손상되지 않았으며, 잔존 갑상선 조직이 없음을 수술 부위를 통하여 확인하여, 수술의 완성도 여부를 평가할 수 있었다. 모든 사체에서 되돌이 후두신경 및 상 또는 하부갑상선의 보존을 확인하였으며, 주변 구조물들의 손상이 없음을 확인하였다. 결 론 로봇이 아닌 후이개 절개를 이용한 내시경 보조 갑상선 절제술은 시행 가능한 접근법 및 수술방법이라 사료된다.

• Journal of Gastric Cancer
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• 제10권2호
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• pp.69-74
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• 2010

Purpose: Laparoscopic gastrectomy has been common treatment modality for gastric cancer. But, most surgeons tend to perform laparoscopy-assisted distal gastrectomy using epigastric incision. Delta-shaped anastomosis is known as intracorporeal gastroduodenostomy, but it is technically difficult and needed many staplers. So we tried to find simple and economical method, here we report on the results of liner-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy. Materials and Methods: We retrospectively reviewed the medical records of 25 patients who underwent totally laparoscopic distal gastrectomy using liner-shaped anastomosis at School of Medicine, Ajou University between January to October 2009. The indication was early gastric cancer as diagnosed by preoperative workup, the anastomoses were performed by using laparoscopic linear stapler. Results: There were 12 female and 13 male patients with a mean age of $55.6{\pm}11.2$. The following procedures were performed 14 laparoscopic gastrectomies, 11 robotic gastrectomies. The mean operation time was $179.5{\pm}27.4$ minutes, the mean anastomotic time was $17.5{\pm}3.4$ minutes. The mean number of stapler cartridges was $5.6{\pm}0.8$. Postoperative complication occurred in one patient, anastomotic stenosis, and the patient required reoperation to gastrojejunostomy. The mean length of postoperative hospital stay was $6.7{\pm}1.0$ days except the complication case, and there was no case of conversion to open procedure and postoperative mortality. Conclusions: Linear-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy is technically simple and feasible method.

• 한국소음진동공학회논문집
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• 제22권12호
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• pp.1220-1226
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• 2012

This paper proposes a novel type of tactile device utilizing magnetorheological(MR) fluid which can be applicable for haptic master of minimally invasive surgery(MIS) robotic system. The salient feature of the controllability of rheological properties by the intensity of the magnetic field(or current) makes this potential candidate of the tactile device. As a first step, an appropriate size of the tactile device is designed and manufactured via magnetic analysis. Secondly, in order to determine proper input magnetic field the repulsive forces of the real body parts such as hand and neck are measured. Subsequently, the repulsive forces of the tactile device are measured by dividing 5 areas. The final step of this work is to obtain desired force in real implementation. Thus, in order to demonstrate this goal a neuro-fuzzy logic is applied to get the desired repulsive force and the error between the desired and actual force is evaluated.

• 한국소음진동공학회:학술대회논문집
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• 한국소음진동공학회 2012년도 추계학술대회 논문집
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• pp.415-420
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• 2012

This paper proposes a novel type of tactile device utilizing magnetorheological (MR) fluid which can be applicable for haptic master of minimally invasive surgery (MIS) robotic system. The salient feature of the controllability of rheological properties by the intensity of the magnetic field (or current) makes this potential candidate of the tactile device. As a first step, an appropriate size of the tactile device is designed and manufactured via magnetic analysis. Secondly, in order to determine proper input magnetic field the repulsive forces of the real body parts such as hand and neck are measured. Subsequently, the repulsive forces of the tactile device are measured by dividing 5 areas. The final step of this work is to obtain desired force in real implementation. Thus, in order to demonstrate this goal a neuro-fuzzy logic is applied to get the desired repulsive force and the error between the desired and actual force is evaluated.