초음파 유도하 상완신경총 차단에서 액와 접근법과 쇄골상 접근법의 비교

서보병,김영우,김종만,이미영,장영호,우상현 대한수부외과학회 2014 대한수부외과학회지 Vol.19 No.3

Purpose: We examined the success rate and adverse effects of ultrasound-guid- ed axillary and supraclavicular approach brachial plexus block. Methods: From December 2013 to February 2014, 580 cases of patients received ultrasound-guided axillary approach or supraclavicular approach brachial plexus block. All blocks were performed by one anesthesiologist under ultra- sound visualization using 0.2% or 0.75% ropivacaine 1% lidocaine with epi- nephrine in 1:200,000 as the anesthetic mixture. Results: Failure rate of ultrasound-guided brachial plexus block was 1.2% and 0.2% in axillary and supraclavicular approach, respectively. In supraclavicular approach brachial plexus block, Honer's syndrome was observed in 17.9%, chest discomfort in 14.9%, and arterial puncture in 1%. There was no adverse effect in axillary approach brachial plexus block. Conclusion: Ultrasound-guided brachial plexus block serves higher success rate and lower occurrence rate of adverse effect and makes it useful for hand and upper extremity surgery. Supraclavicular approach has relatively higher success rate and lower rate of adverse effect than axillary approach. 목적: 초음파 유도하 액와 접근법 및 쇄골상 접근법에 의한 상완신경총 차단(brachial plexus block, BPB)의 성공률과합병증을 조사하고자 하였다. 방법: 2013년 12월부터 2014년 2월까지 총 580건에서 초음파 유도하 액와 접근법 및 쇄골상 접근법에 의한 BPB가 시행되었다. 모든 BPB는 한 명의 마취통증의학과 의사에 의하여 시행되었다. BPB는 0.2% 혹은 0.75% 로피바카인과 1% 리도카인 혼합 용액에 1: 200,000 에피네프린을첨가하여 시행되었다. 결과: 초음파 유도하 BPB의 실패율은 액와 접근법 시 1.2%, 쇄골상 접근법 시 0.2%이었다. 쇄골상 접근법에 의한BPB 시 호너증후군이 17.9%, 흉부 불편감이 14.9%, 동맥 천자가 1%에서 발생되었다. 액와 접근법에 의한 BPB 시에는 별다른 합병증이 발생되지 않았다. 결론: 초음파의 사용은 수부 및 상지 수술 마취 시 BPB의 성공률을 높이고 합병증을 줄이는 유용한 방법이다. 쇄골상접근법이 액와 접근법에 비하여 상대적으로 성공률이 높으며 합병증 발생률도 더 높다.

단일 기관에서 10년간 시행한 갑상선 미세유두암의 내시경 갑상선 절제술의 경험

김영은(Yeoung-Eun Kim),곽하나(Ha-Na Kwak),김준호(Jun Ho Kim),최윤정(Yoon Jung Choi),윤지섭(Ji-Sup Yun),손병호(Byung Ho Son),박용래(Yong-Lai Park) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.5

Purpose: Endoscopic thyroid surgery has been widely used because of the cosmetic advantage and the development of laparoscopic instruments. We have performed endoscopic thyroidectomy by breast approach and gasless transaxillary approach on papillary thyroid microcarcinomas. In this study, we describe these two types of endoscopic procedures with the technique of the method and surgical outcomes. Methods: From Oct. 1999 to Oct. 2009, each procedure was performed in 162 patients divided into two groups. Breast approach group was in 91 patients and gasless transaxillary approach group was in 71 patients. We compared the results of mean ages, sex ratio, extent of operation, mean hospital stay, operating time, pathologic characteristics and postoperative complications between the breast approach group and gasless transaxillary approach group. Results: Ninety-one cases treated using breast approach, and seventy-one cases treated using gasless transaxillary approach. The operation time was 197.4±60.7 minutes (95∼350) in breast approach group, and 100.1±19.8 minutes (65∼140) in gasless transaxillary approach group. Post operative complications are; 2 cases of transient hoarseness, 8 cases of hypocalcemia (including 2 cases of permanent hypocalcemia), 2 cases of chest wall discomfort in breast approach group, and 1 case of transient hoarseness, 2 cases of transient hypocalcemia, 1 case of postoperative bleeding in gasless axillary approach group. Conclusion: Endoscopic thyroidectomy is a safe and technically feasible alternative to conventional thyroidectomy in patients with benign and highly selected malignant disease. We expect it can increase the extent of surgery.

액와 단일절개 접근법을 이용한 내시경적 갑상선 절제술

김소영(So young Kim),유윤종(Yoonjong Ryu),정우진(Woo-Jin Jeong),안순현(Soon-Hyun Ahn) 대한두경부종양학회 2012 대한두경부 종양학회지 Vol.28 No.2

Background and Objectives:To assure the surgical completeness of the gasless endoscopic thyroidectomy via single incision axillary approach using flexible videoscope which provide wide angle and working space, we compared single incision axillary approach and axillo-areolar approach by means of clinical, surgical outcomes. Materials and Methods:From March 2011 to July 2012, 24 patients who had underwent endoscopic thyroid-ectomy via transaxillary approach were enrolled. Of total, 17 patients underwent single incision axillary ap-proach(group I) and the other 7 underwent axillo-areolar approach(group II). Results:Patient demographics, surgical indications were similar between the two groups. The operating time(group I 144.6min, group II 153.6 min ; p=.29), blood loss(group I : 55.4cc, group II : 35.7cc : p=.64), hospital stay(group I : 4.2days, group II : 4.4 days ; p=.65) were similar in the two groups. Overall, two patients in group I(2/17, 11.8%) experienced post-operative complications, including one hematoma and one seroma. Due to narrow working space, one patient was change to axillo-areolar approach during single incision axillary approach with 30° rigid endoscope. Conclu-sion:Single incision axillary approach is safe and effective similar to other endoscopic thyroidectomy methods using flexible videoscope. Different with 30° rigid endoscope, 10-mm flexible videoscope can put inside the ax-illary inicision site in different axis with endoscopic instruments. This difference in endoscopic axis help to pre-vent crash with endoscopic instrument.

액와접근법을 이용한 무기하 내시경 갑상선 절제술 후 국소 부위 통증 조절 장치(On-Q^Ⓡ PainBuster^Ⓡ)와 자가 통증 조절 장치의 무작위 대조 연구에 대한 예비 자료

이경원,박찬흔,박용래,현기훈,윤지섭,Kyung-Won Lee,Chan-Heun Park,Yong-Lai Park,Ki-Hun Hyun,Ji-Sup Yoon 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.4

Purpose: Gasless transaxillary approach to endoscopic thyroidectomy is a widely performed procedure for benign or malignant thyroid neoplasms. However, it requires wide dissection for approaching the target area. The intravenous patient-controlled analgesia (IV PCA) is an effective method for postoperative pain control and patients can use it according to their requirement. However, patients suffer from nausea, vomiting, sleep disturbance, etc. due to opioids. Pain pump ON-Q^Ⓡ PainBuster^Ⓡ (pain buster) has been used widely in various surgeries for control of postoperative localizing and wide area pain without side effects of opioid analgesia because it consists of Ropivacaine. Methods: From Aug. 2008 to Jan. 2013, Gasless transaxillary endoscopic thyroidectomy was performed in 90 patients in a single institution, who were divided into three groups, including the IV PCA, pain buster, and null groups. We compared postoperative outcomes, pain severity between groups. We recorded scores immediately, 6, 12, 24, and 48 hours after surgery following visual analog pain score (VAS), and investigated hospital stay and occurrence of events of nausea, vomiting, and complications. Results: In the IV PCA group, it was discontinued due to nausea in 36.7% of patients. No significant difference in pain severity following VAS score was observed among the three groups. However, smaller numbers of analgesia injections were required in the Pain buster group than in the other groups, and fewer patients suffered from constipation, compared with the PCA group. Conclusion: Pain buster showed even effects compared to IV PCA, with few side effects and less discomfort of patients, compared with the other groups. Therefore, pain buster was thought to be the proper method for pain control after dissection of the anterior chest wall, cervical area in order to secure an operative view for transaxillary endoscopic thyroi-dectomy.

액와접근법을 이용한 무기하 내시경적 갑상선절제술 30예

박준호,윤종호,박찬흔,Jun Ho Park,M.D.,Jong Ho Yoon,M.D. and Chan Heun Park,M.D. 대한갑상선-내분비외과학회 2005 The Koreran journal of Endocrine Surgery Vol.5 No.2

Purpose: Surgery for thyroid disease requires a skin incision that can result in postsurgical problems such as prominent scars, adhesions, hypesthesia, and paresthesia in the neck. To overcome these problems, we performed a gasless endoscopic thyroidectomy via an axillary approach. Methods: Between May 2004 and April 2005, 30 female patients underwent gasless endoscopic thyroidectomy via an axillary approach. Surgical outcomes were evaluated in terms of operating time, length of hospital stay, and the incidence of perioperative complications. Patient opinion was assessed using a verbal response scale at two and four months after surgery. Results: The mean operating time was 126.8⁑32.4 minutes, and the mean length of hospital stay was 4.3⁑1.1 days. No cases required conversion to open surgery and none involved significant intraoperative complications. Three patients (10.0%) complained slight hypesthesia or paresthesia in the anterior chest wall, and only 2 patients (6.7%) complained the discomfort while they were swallowing for 4 months after surgery. All patients were satisfied with the cosmetic results. Conclusion: Gasless endoscopic thyroidectomy via an axillary approach is feasible and safe and provides excellent cosmetic results with a minimal degree of postoperative complaints. This procedure provides another surgical option for the treatment of benign thyroid disease in selected patients. (Korean J Endocrine Surg 2005;5:81-86)

액와접근법을 이용한 무기하 내시경 갑상선 절제술(예비보고)

태경,김수영,이용섭,이형석 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.3

Background and Objectives:Surgical treatments for thyroid diseases require skin incisions that can result in prominent scars in the anterior neck. For a reduction in scar size or the elimination of scar in the neck, the various kinds of minimally invasive thyroi-dectomies were reported. In this study, we report our early experience of endoscopic thyroidectomy by the axillary approach. Subjects and Method:Between February 2005 and October 2005, 12 patients underwent endoscopic thyroidectomy by gasless axillary approach. We assessed pathologic diagnosis, duration of operation, size of thyroid tumor and complication of our experi-ment of endoscopic thyroidectomy. Results:Endoscopic procedures were performed successfully in 11 cases (3 total lobectomy, 5 subtotal lobectomy and 3 lumpectomy). Conversion to conventional thyroidectomy was required in one patient because of recur-rent laryngeal nerve injury and tracheal laceration. Final histopathologic diagnoses were 7 cases of adenomatous hyperplasia, 4 follicular adenoma, 1 papillary carcinoma. The mean operating time was 302 minutes and it gradualy became shorter. Conclusion:Gasless endoscopic thyroidectomy via axillary approach may be a safe and technically feasible procedure that leads to an improved cosmetic result. (Korean J Otolaryngol 2007 ;50 :252-6)

액와접근법을 이용한 무기하 내시경적 갑상선절제술: 단기 추적 관찰 결과 및 접근법의 변형

유태석,정진철,윤종호,Tae Suk You,M,D,Jin Cheol Jeong and Jong Ho Yoon 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.1

액와접근법을 이용한 무기하 내시경적 갑상선 절제술: 634예에 대한 수술 결과

강상욱,정종주,윤지섭<SUP>1<,SUP>,성태연,이승철,이용상,남기현,장항석,정웅윤,박정수,Sang-Wook Kang,Jong Ju Jeong,Ji-Sup Yoon,<SUP>1<,SUP>,Tae Yon Sung,Seung Chul Lee,Yong Sang Lee,Kee-Hyun Nam,Hang Seok Chang,Woong Youn Chung,and Ch 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.1

무기하 액와 접근법을 이용한 로봇 갑상선 절제술: 단일 술자에 의한 최초 1년간의 경험

노재형,이정훈,나국영,이잔디,정웅윤<SUP>1<.SUP>,소의영,Jae Hyung Noh,Jeong Hun Lee,Kuk Young Na,Jandee Lee,Ph.D.,Woong Youn Chung Ph.D.<SUP>1 <.SUP>and Euy Young Soh,Ph.D. 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.3

Purpose: Various endoscopic thyroidectomy procedures have been designed to minimize visible cervical scarring. However, endoscopic thyroidectomy is a technically challenging procedure that is performed by a limited surgeon. Robotic systems aida surgeon in performing minimally invasive head and neck surgery by offering superior visualization and dexterity. This study reports the initial experience of one surgeon with robotic thyroidectomy to assess the technical feasibility and safety of the approach. Methods: One hundred four thyroid cancer patients (97 females, 7 males; mean age of 39.8±8.1 years) underwent robotic thyroidectomy using gasless transaxillary approach between November 2008 and October 2009 in Ajou University Hospital. All the procedures were completed successfully using the da Vinci surgical system without open conversion. Patient characteristics, postoperative clinical results, complications, and pathologic details were assessed. Results: Total thyroidectomy was performed in 25 (24.0%) patients, subtotal thyroidectomy in 13 (12.5%) patients, and unilateral lobectomy in 66 (63.5%) patients. All patients underwent ipsilateral central compartment neck dissection, and two patients underwent selective lymph node (LN) dissection. The mean operation time was 134.5±47.2 min (range 61∼310 min), in which the actual time for the thyroidectomy with lymphadenectomy (console time) was 56.4 min. (range 31∼270). The mean number of LN resected was 3.9 (range 0∼28). There were no serious complications. The mean hospital stay was 2.9±0.9 days (range 2∼7). Conclusion: Robotic thyroidectomy is a feasible, safe, and cosmetically excellent procedure. The application of robotic technology for thyroid surgeries could be an alternative to endoscopic or conventional open thyroidectomy. (Korean J Endocrine Surg 2010;10:157-162)

양성 갑상선 종양에서의 액와 접근법을 통한 무기하 내시경 갑상선 절제술

이준상,강상욱,정종주,성태연,이승철,이용상,남기현,장항석,정웅윤,박정수 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.3

Purpose: The techniques for minimally invasive surgery in various surgical fields have recently become markedly developed. The endoscopic surgical methods for head and neck surgery have been introduced somewhat later due to some technical limitations. However, various endoscopic techniques have been remarkably developed during the last 10 years. We also introduced a novel method of gasless endoscopic thyroidectomy using the trans-axillary approach. The aim of this study is to evaluate the feasibility and surgical outcome of this method for treating patients with benign thyroid tumor.