• Archives of Plastic Surgery
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• 제49권1호
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• pp.34-38
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• 2022

The deep inferior epigastric perforator (DIEP) flap has been widely used for autologous breast reconstruction after mastectomy. In the conventional surgical method, a long incision is needed at the anterior fascia of the rectus abdominis muscle to obtain sufficient pedicle length; this may increase the risk of incisional hernia. To shorten the incision, several trials have investigated the use of endoscopic/robotic devices for pedicle harvest; however, making multiple additional incisions for port insertion and operating in the intraperitoneal field were inevitable. Here, we describe the first case, in which a DIEP free flap was successfully made using the da Vinci SP model. Our findings can help surgeons perform operations in smaller fields with a single port in the extraperitoneal space. Moreover, this method is expected to lead to fewer donor-related complications and faster healing.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2009년도 춘계학술대회
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• pp.278-278
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• 2009

• Journal of Gastric Cancer
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• 제18권2호
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• pp.182-188
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• 2018

Purpose: Despite the fact that there are several reports of single-port laparoscopic distal gastrectomy (SPDG), no analysis of its learning curve has been described in the literature. The aim of this study was to investigate the favorable factors for SPDG and to analyze the learning curve of SPDG. Materials and Methods: A total of 125 cases of SPDG performed from November 2011 to December 2015 were enrolled. All operations were performed by 2 surgeons (surgeon A and surgeon B). The moving average method was used for defining the learning curve. All cases were divided into 10 cases in a sequence, and the mean operative time and estimated blood loss data were extracted from each group. Results: Surgeon A performed 68 cases (female-to-male sex ratio, 91.1%:8.82%), and surgeon B performed 57 cases (female-to-male sex ratio, 61.4%:38.5%). The operative time of surgeon B significantly decreased after 30 cases ($157.8{\pm}38.4$ minutes vs. $118.1{\pm}34.5$ minutes, P=0.003); that of surgeon A did not significantly decrease before and after around 30 cases ($160.8{\pm}51.6$ minutes vs. $173.3{\pm}35.2$ minutes, P=0.6). The subgroup analysis showed that the operative time significantly decreased in the patients with body mass index (BMI) of <$25kg/m^2$ (<$25kg/m^2$:${\geq}25kg/m^2$, $159.3{\pm}41.7$ minutes: $194.25{\pm}81.1$ minutes; P=0.001). Conclusions: Although there was no significant decrease in the operative time for surgeon A, surgeon B reached the learning curve upon conducting 30 cases of SPDG. BMI of <$25kg/m^2$ was found to be a favorable factor for SPDG.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2008년도 추계학술대회
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• pp.165-165
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• 2008

• Advances in pediatric surgery
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• 제14권1호
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• pp.67-74
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• 2008

The usefulness of totally implantable central venous port for long-term intravenous infusion is widely accepted in children. Usually the catheters are placed through the internal or external jugular vein. In case of jugular vein cut-down, two separate incisions are needed for catheter and port respectively. Patients also feel uncomfortable as the catheter run through the neck. However these disadvantages can be overcome by using the cephalic vein (CV). We reviewed our experiences on CV cut-down for totally implantable central venous port in children. From January 2002 to December 2006, 201 patients (M:F=127:74) underwent 218 central venous port insertions. Mean age at operation was 5.9 years (2 months - 19 years). Indications included chemotherapy (N=167), long-term intravenous antibiotics infusion (N=36), and total parenteral nutrition (N=15). CV was selected preferentially. The incision includes the deltopectoral triangle laterally, and both the CV cut-down and port insertion were achieved with a single incision. The number of insertion through external, internal jugular vein, and CV was 77, 66 and 75, respectively. The median age, height and body weight were higher in CV cut-down group. The youngest age for CV cut-down was 8 months, the shortest height was 69 cm and the smallest body weight was 5.9 kg. Of 118 trials of CV cut-down, cut-down was successful in 75 cases (63.6 %). CV was absent in 10 cases(8.4 %) and CV was sacrificed after catheter tip malposition in 10 cases (8.4 %). There was only one complication, in which the catheter was inserted into the minute branch of subclavian artery. The CV cut-down method for totally implantable central venous port was safe and feasible in selected groups of patients in children. In addition, preservation of jugular vein and a more favorable cosmetic effect are other benefits of CV cut-down.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2008년도 춘계학술대회
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• pp.96-96
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• 2008

• 한국임상수의학회지
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• 제28권6호
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• pp.555-561
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• 2011

본 연구에서는 중 소형견에서 1개의 복강경 통로를 통한 내시경적 담낭 제거술을 실시함으로써, 개에서 최소 침습적 수술로 담낭 절제술을 실시할 수 있는 방법을 확립하기 위하여 실시하였다. 실험 동물로 총 3마리의 수컷 비글견 ($10.3{\pm}0.62$ kg)을 이용하였으며 배꼽 주위에 하나의 절개창을 만든 후 단일 통로 내시경 시스템을 장착하였다. 이 시스템을 통해 내시경과 Maryland 복강경용 겸자로 담낭을 견인, 제거하였다. 3마리 모두 성공적으로 담낭 절제술을 실시하였으며, 수술 후 감염과 같은 합병증은 발생하지 않았다. 또한 술전, 술후를 비교한 혈액, 혈청 검사상에서도 특이적인 소견은 관찰되지 않았다. 술후 7일 후에 이루어진 부검 소견에서도 출혈 및 담즙의 유출 및 복막염 등과 같은 부작용은 관찰되지 않았다. 따라서 본 연구를 통해, 단일 통로를 이용한 내시경 유도하 담낭 절제술은 중소형견에서 실시할 수 있는 복강 수술 방법 중 최소한의 절개를 통해 비침습적으로 이루어질 수 있는 유용한 수술 방법이라 할 수 있다.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2009년도 추계학술대회
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• pp.262-262
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• 2009

• 한국간담췌외과학회지
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• 제27권4호
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• pp.372-379
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• 2023

Backgrounds/Aims: While single-incision laparoscopic cholecystectomy (SILC) has advantages in cosmesis and postoperative pain, its utilization has been limited. This study raises the possibility of expanding its indication to acute cholecystitis with the novel method of solo surgery under retrospective analysis. Methods: We compared the outcomes of SILC (n = 58) to those of three-incision laparoscopic cholecystectomy (TILC; n = 117) for acute cholecystitis, being performed from March 2014 to December 2015. Results: Intraoperative results, including the operation time, did not differ significantly, except for drain catheter insertion (p = 0.004). Each group had 1 case of open conversion due to common bile duct injury. There was no significant difference in the length of hospital stay. Either group by itself was not a risk factor for complications, but in preoperative drainage for intraoperative perforation, 3 factors of intraoperative perforation, biliary complication, and history of upper abdominal operation for additional port, only American Society of Anesthesiology (ASA) scores for postoperative complication of Clavien-Dindo grades III and IV were significant risk factors. Conclusions: Our study findings showed comparative outcomes between both groups, providing evidence for the safety and feasibility of SILC for acute cholecystitis.

• Archives of Plastic Surgery
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• 제48권2호
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• pp.194-198
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• 2021

Robot-assisted nipple-sparing mastectomy with immediate reconstruction is currently performed in an attempt to seek smaller and indistinct incisions. Robotic surgery system has been evolving under the concept of minimal invasive technique which is a recent trend in surgery. One of the latest version is the da Vinci SP Surgical System (Intuitive Surgical). In this report, we will share our experiences. Two patients underwent robot-assisted nipple-sparing mastectomy, each followed by immediate robot-assisted expander insertion and prepectoral direct-to-implant breast reconstruction, respectively. There was no open conversion or major postoperative complication. One patient experienced mild infection, which was resolved by intravenous antibiotic treatment. Simple docking process, multi-joint instruments, and thirdarm functionality are among the new surgical system's advantages. The present cases suggest that robot-assisted nipple-sparing mastectomy with immediate reconstruction using the da Vinci SP Surgical System is feasible and safe. The promising features and potential application of da Vinci SP in breast reconstruction need further study.