• Journal of Chest Surgery
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• v.31 no.6
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• pp.581-585
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• 1998

Postoperative autotransfusion is known as an effective method for blood conservation. We tried to examine whether the autotransfusion of shed mediastinal blood in patients with unstable angina would be valuable for reducing postoperative homologous transfusion by observing the hourly tendency of bleeding and transfusion. Between August and October, 1997, 26 patients with unstable angina underwent coronary arterial bypass surgery by a single surgeon at Asan Medical Center. In retrospective analysis, we found 90% of the patients received homologous transfusions and 85% of them were in the intensive care unit at the same day after operation. In many patients, the cause of transfusion was not anemia but volume replacement. Mean bleeding through the chest tubes was 340 cc for the first 5 hours and 69%(18 pts) showed more than 200 cc of bleeding, the amount generally considered as a initiating point for autotransfusion. Despite the adoption of multiple methods for blood conservation, 90% of the patients needed homologous transfusion. Moreover, many of them had received unnecessary transfusions. We conclude that some kind of blood for transfusion is needed during the immediate postoperative period, and the adoption of postoperative autotransfusion may help in reducing homologous transfusion.

• Journal of Chest Surgery
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• v.51 no.5
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• pp.344-349
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• 2018

Background: We report our surgical technique for nonintubated uniportal video-assisted thoracoscopic surgery (VATS) pulmonary resection and early postoperative outcomes at a single center. Methods: Between January and July 2017, 40 consecutive patients underwent nonintubated uniportal VATS pulmonary resection. Multilevel intercostal nerve block was performed using local anesthesia in all patients, and an intrathoracic vagal blockade was performed in 35 patients (87.5%). Results: Twenty-nine procedures (72.5%) were performed in patients with lung cancer (21 lobectomies, 6 segmentectomies, and 2 wedge resections), and 11 (27.5%) in patients with pulmonary metastases, benign lung disease, or pleural disease. The mean anesthesia time was 166.8 minutes, and the mean operative duration was 125.9 minutes. The mean postoperative chest tube duration was 3.2 days, and the mean hospital stay was 5.8 days. There were 3 conversions (7.5%) to intubation due to intraoperative hypoxemia and 1 conversion (2.5%) to multiportal VATS due to injury of the segmental artery. There were 7 complications (17.5%), including 3 cases of prolonged air leak, 2 cases of chylothorax, 1 case of pleural effusion, and 1 case of pneumonia. There was no in-hospital mortality. Conclusion: Nonintubated uniportal VATS appears to be a feasible and valid surgical option, depending on the surgeon's experience, for appropriately selected patients.

• Journal of Korean Neurosurgical Society
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• v.48 no.2
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• pp.139-144
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• 2010

Objective : We report our surgical experience in the treatment of 16 consecutive patients with benign craniovertebral junction (CVJ) tumor, observed from 2003 to 2008 at our department. Methods : We had treated 6 foramen magnum meningiomas, 6 cervicomedullary hemangioblastomas, 1 accessory nerve schwannoma, 1 hypoglossal nerve schwannoma, 1 C2 root schwannoma, and 1 cavernous hemangioma. Clinical results were evaluated by Karnofsky Performance Scale (KPS) and all patients underwent preoperative neuroradiological evaluation with computed tomography (CT) and magnetic resonance image (MRI). Angiography was performed in 15 patients and preoperative embolization was done in 2 patients. Results : Five far-lateral, 1 supracondylar and 10 midline suboccipital approaches were performed. Gross total removal was achieved in 15 cases (94%) and subtotal removal in 1 patient (6%). None of the patients required occipitocervical fusion. Radiological follow-up showed no recurrence in cases totally removed. Postoperative decrease of KPS scores was recorded in only 1 patient. The treatment of cervicomedullary solid hemangioblastoma presented particular issues : by preoperative embolization, we removed tumor totally without an excessive bleeding or brainstem injury. In one of foramen magnum meningioma, we carried out subtotal removal due to hard tumor consistency and encasement of neurovascular structures. Conclusion : The choice of surgical approaches and the extent of bone resection should be defined according to the location and size of individual tumors. Moreover, we emphasize that preoperative neuroradiological evaluations on presumptive tumor type could be helpful to the surgeon in tailoring the technique and providing the required exposure for different lesions, without unnecessary surgical steps.

• Archives of Plastic Surgery
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• v.37 no.2
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• pp.143-147
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• 2010

Purpose: Nostril stenosis is an uncommon deformity that develops as a consequence of smallpox, chickenpox, tuberculosis, syphilis, congenital malformations etc. There have been several studies on the surgical techniques to treat it. However, it is difficult to maintain the result for a long time. The goal of this study is to evaluate the use of Wplasty, perialar flap as an operative techniques and expansion exercise using Foley catheter as a method to keep the patency of nostril. Methods: This is a retrospective review of the senior surgeon's (Y.L.) patients who underwent W-plasty and a perialar flap. Patients treated from 2005 to 2009 were reviewed and the postoperative results were evaluated. Average patient age was 24 years, ranged from 1 to 61 years, average follow-up period was 27.5 months, ranged from 3 to 77 months. The mild deformity was released with an incision and expansion by the ballooning of a Foley catheter and corrected by W-plasty only. However, a severe deformity required an additional procedure including perialar flap transposition. During the postoperative period, the patients maintained a nasal stent and exercise using a Foley catheter to prevent recurrence. Results: Five cases of nostril stenosis in four patients were treated using this technique. One case was corrected with W-plasty only, but four cases were more severe and were corrected with W-plasty and a perialar flap. There were no perioperative complications. The patients were satisfied with the results and retained a good shape during the follow-up periods. Conclusion: Nostril stenosis can be corrected with W-plasty and a perialar flap. A perialar flap is added if W-plasty is unable to correct the deformity. A postoperative nasal stent and expansion with a Foley catheter can help in preventing recurrences.

• 한국HCI학회:학술대회논문집
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• 2009.02a
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• pp.203-213
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• 2009

Medicine is one of great application fields where Virtual Reality (VR) technologies have been successfully utilized. The VR technologies in medicine bring together an interdisciplinary community of computer scientists and engineers, physicians and surgeon, medical educator and students, military medical specialists, and biomedical futurists. The primary feedback of a VR system has been visual feedback. The complex geometry for graphic objects and utilizing hardware acceleration can be incorporated with in order to produce realistic virtual environments. To enhance human-computer interaction (HCI), in term of immersive experiences perceived by users, haptic, speech, olfactory and other non-traditional interfaces should also be exploited. Among those, hapic feedback has been tightly coupled with visual feedback. The combination of the two sensory feedbacks can give users more immersive, realistic and perceptive VR environments. Haptic feedback has been studied over decades and many haptic based VR systems have been developed. This paper focuses on haptic feedback in term of its medical usages. It presents a survey of haptic feedback techniques with their applications in medicine.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.5
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• pp.359-367
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• 2004

Purpose: After the surgical correction with sagittal split ramus osteotomy, the position of the mandibular condyle in the glenoid fossa and the proximal segment of the mandible change because of bony gap between proximal and distal segment, especially in case of mandibular setback asymmetrically. In this study, positional changes in the condyle and proximal segment after BSSRO were estimated in the mandibular asymmetry patient by analyzing the in submentovertex view and P-A cephalogram for identification of ideal condylar position during surgery. Patients and Methods: The 20 patients were selected randomly who visit Dankook Dental Hospital for mandibular asymmetry. Bilateral sagittal split ramus osteotomy with rigid fixation was performed and P-A cephalogram and submentovertex view was taken at the time of preoperative, immediate postoperative, 3 month postoperative period. Results: Intercondylar length and transverse condylar angle was increased due to inward rotation of proximal segment and anteromedial rotation of lateral pole of condyle head. The condylar position had a tendency to return to the preoperative state and after 3 months return up to about half of the immediate post-operative changes, and all the results showed more changes in asymmetry patient and deviated part of the mandible. Conclusion: Based on all these results above, surgeon should make efforts to have a precise preoperative analysis and to have a ideal condylar position during rigid fixation after BSSRO.

• Journal of Chest Surgery
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• v.31 no.11
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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.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.128-136
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• 1996

Radial nerve injury is caused by variety of etiologies, mainly traumatic. It is primarily a motor nerve and loss of it's function leads to a significant disability. Surgical treatments of radial nerve comprise of neurolysis(internal or external), neurorrhaphy(eineural, perineural or epi-perineural), nerve graft and tendon transfer. However, there is still controversies in treatment methods and time of operation. Authors experienced 23 cases of radial nerve injuries who were treated by operative methods and followed up over 1 year's duration. The male to female ratio was 18 to 5 and mean age was 30.7 years old. The causes were 13 cases in fractures, 5 cases in crushing injury, 3 cases in laceration, 1 case in CO poisoning and 1 case in unknown cause. The summary of the study were as follows ; 1. Excellent or good results were obtained in overall 16 cases among 23 cases; 5 of 9 cases in neurolysis, 3 of 3 cases in neurorrhaphy, 2 of 3 cases in nerve graft and 6 of 8 cases in tendon transfer. 2. In cases of neurorrhaphy and nerve graft, primary or delayed repair showed excellent or good results and neurolysis performed before 6 months leads to better results. But there was no correlations between the time of injury and operation in tendon transfer. 3. The radial nerve injury associated with extensive soft tissue defect or any conditions that leads to nerve ischemia results poor prognosis. 4. The patients aged under 40 years showed better prognosis in clinical results according to the age of surgical treatment. 5. If the surgeon decide the method and the time of operation through the exact evaluation of the factors which influencing the end result such as age of the patient, level and type of injury, extent of nerve lesion and the associated tissue injury, good result could be expected.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.46-55
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• 1996

The purpose of this study is to investigate if there is a higher rate of free flap failure in cases of vein grafts compared to non-vein graft, and to analyze the clinical usefulness and necessity in elective free flap surgery. We have used 24 vein grafts in 208 free flaps from May, 1986 until August, 1995. Vein grafts were from 2cm to 50cm in length between the recipient and donor vessels. Reconstructed sites were 10 lower extremities, 8 head and neck, 4 hand, and 2 trunk. Vein grafts were used 14 for arterial, 6 venous, 4 in both arterial and venous anastomoses. We intentionally used long vein grafts longer than 5cm for improved blood flow in cases of peripheral vascular disease, radionecrotic wounds, lower leg trauma. Short vein grafts of about 3cm in length were used to overcome the shortage of vascular length in cases of unexpected vessel anomaly, short donor vessel, and difficult access to recipient vessels after radical neck dissection. All veins were carefully handled with ligation of very small branches and were transferred to the recipient site without irrigation. 8 flaps were failed out of a total of 208 free flaps, however there was no failure among the 24 cases that needed vein grafts between the donor and recipient vessels. Success rates between non-vein grafts free flaps and vein graft free flaps were 95.6%(8/184) and 100%(0/24). Even though the vein grafts increase the operation time and the number of anastomoses, they do not result in any increased failure rate of free flap surgery(4.4% versus 0%). In addition to the reducing tension between recipient and donor vessels, the surgeon can select better recipient vessels with excellent blood flow so that vein grfats in microsurgery can provide a high success rate of free flaps.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.37-40
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• 2010

Purpose: Reconstruction of eyebrow defects after wide excision of the benign and malignant tumors present a cosmetic challenge to the plastic surgeon. There were several methods for reconstruction of partial eyebrow defect with local flaps except hair bearing composite graft. We introduce simple eyebrow reconstruction with bilateral advancement flap and tattooing on the idea that eyebrow tattooing is popular permanent eyebrow makeup among elderly Korean women. Methods: The flaps were designed on both ends of the eyebrow defect along the upper and lower margin of the eyebrow. Both flaps were cut, undermined and were moved centrally to cover the defect. Both flaps were attached along the vertical suturing line. The rest of each flap was sown with dog-ears revised minimally. Scar lines would be hidden along the natural borders of the eyebrow if possible. The resulting vertical scar finally was covered with hair. After 8 months, eyebrow tattooing would be done to camouflage eyebrow shortening and scar. Results: Partial eyebrow defect was reconstructed successfully with bilateral advancement flap and tattooing. The postoperative scar was inconspicuous and eyebrow looked symmetric. Conclusion: We recommend partial eyebrow reconstruction with bilateral advancement flap and tattooing for the elderly Korean female patients after excision of small tumor in and around eyebrow region.