결핵성 늑막 삼출증 환자에서 비디오 흉강경을 이용한 수술

배기만 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.9 No.-

Tuberculous pleurisy is a common clinical manifestations and the traditional methods of treatment are anti-tuberculous medication and thoracentesis. However, high incidence of complications and prolonged hospital stay occurring with the traditional treatment necessitated new therapeutic modalities. Recently, the VATS(video-assisted thoracoscopic surgery) was introduced and rapid progression of its indications and techniques were made and we evaluated the effectiveness of the VATS in tuberculous pleurisy patients. From Mar.1997 to Feb. 1999, 45 patients with tuberculous pleurisy underwent video-assisted thoracoscopic pleural biopsy and closed thoracostomy drainage. The mean operative time was 27.3±5.5 minutes and mean duration of chest tube indwelling was 5.5±1.6 days with the mean hospital stay of 8.6±2.6 days. The most frequently occurring complications were dead spae in the pleural cavity and atelectasis although they were not significant. The follow up chest X-ray revealed excellent recovery in 16(35.6%) cases, good recovery in 20(44.4%) cases, fair recovery in 6(13.3%) cases and poor recovery in 3(6.6%) cases. In this study, video-assisted thoracoscopic pleural biopsy and drainage is relatively easy resulting excellent outcomes and minimal complications, therefore, we think that VATS is effective methods in treating patients with the tuberculous pleurisy.

Clinical Analysis of Video-assisted Thoracoscopic Spinal Surgery in the Thoracic or Thoracolumbar Spinal Pathologies

Kim, Sung-Jin,Sohn, Moon-Jun,Ryoo, Ji-Yoon,Kim, Yeon-Soo,Whang, Choong-Jin The Korean Neurosurgical Society 2007 Journal of Korean neurosurgical society Vol.42 No.4

Objective : Thoracoscopic spinal surgery provides minimally invasive approaches for effective vertebral decompression and reconstruction of the thoracic and thoracolumbar spine, while surgery related morbidity can be significantly lowered. This study analyzes clinical results of thoracoscopic spinal surgery performed at our institute. Methods : Twenty consecutive patients underwent video-assisted thoracosopic surgery (VATS) to treat various thoracic and thoracolumbar pathologies from April 2000 to July 2006. The lesions consisted of spinal trauma (13 cases), thoracic disc herniation (4 cases), tuberculous spondylitis (1 case), post-operative thoracolumbar kyphosis (1 case) and thoracic tumor (1 case). The level of operation included upper thoracic lesions (3 cases), midthoracic lesions (6 cases) and thoracolumbar lesions (11 cases). We classified the procedure into three groups: stand-alone thoracoscopic discectomy (3 cases), thoracoscopic fusion (11 cases) and video assisted mini-thoracotomy (6 cases). Results : Analysis on the Frankel performance scale in spinal trauma patients (13 cases), showed a total of 7 patients who had neurological impairment preoperatively : Grade D (2 cases), Grade C (2 cases), Grade B (1 case), and Grade A (2 cases). Four patients were neurologically improved postoperatively, two patients were improved from C to E, one improved from grade D to E and one improved from grade B to grade D. The preoperative Cobb's and kyphotic angle were measured in spinal trauma patients and were $18.9{\pm}4.4^{\circ}$ and $18.8{\pm}4.6^{\circ}$, respectively. Postoperatively, the angles showed statistically significant improvement, $15.1{\pm}3.7^{\circ}$ and $11.3{\pm}2.4^{\circ}$, respectively(P<0.001). Conclusion : Although VATS requires a steep learning curve, it is an effective and minimally invasive procedure which provides biomechanical stability in terms of anterior column decompression and reconstruction for anterior load bearing, and preservation of intercostal muscles and diaphragm.

Microinvasive Video-assisted Thoracoscopic Sympathicotomy for Primary Palmar Hyperhidrosis

Kim, Bo-Young 조선대학교 2000 The Medical Journal of Chosun University Vol.25 No.2

배경 : 일차성 수부다한증에서 흉강경을 사용한 교감신경절제술이 선택적으로 사용되고 있지만 적절한 수기에 관해서는 논란의 여자가 있다. 저자는 2mm 흉강경과 2개의 접근로(Port)를 사용하여 교감신경절제술을 시행하였고 이의 단기성적을 평가하였다. 방법 : 45명(남자 20명, 여자 25명)의 환자를 대상으로 후향적조사를 시행하였고 평균연령은 24.2세였다. 1998년 4월부터 1999년 8월까지 90례(일차성 수부다한증은 56례, 액와부와 족부다한증을 동반한 34례)의 비데오흉강경교감신경절제술을 시행하였으며 평균추적기간은 11.3개월이었다. 환자의 만족도와 합병증 및 유병율을 중점적으로 조사하였다. 결과 : 전례에서 수술즉시 다한증이 개선되었으며 사망률은 없었고 한례의 일시적 호너증후군이 발생하였다. 수부다한증에 동반된 족부다한증 20례중 8례에서 개선의 효과가 있었으며 전환자의 평균만족도는 92±2퍼센트였다. 추적기간동안에 보상성다한증과 일식적 호너증후군을 호소한 단 2례에서만 수술에 대한 불만을 나타냈다. 결론 : 2mm 흉강경을 이용한 흉부교감신경절제술은 수부다한증을 교정하는 데 빠르고 안전하며 미미한 합병증으로 최대의 미용적효과를 거둘 수 있는 수술기법이다. Background : Although video-assisted thoracoscopic surgery for palmar hyperhidrosis is now widely accepted as the approach of choice, the optimal technique has remained a subject of controversy. We have used 2-mm dual port video-assisted thoracoscopic Sympathicotomy for primary palmar hyperhidrosis. This study evaluates the short-term results of the technique. Methods : A retrospective review was carried out of 45 patients, 20 men and 25 women, with a mean age of 24.2 years. In the period from April 1998 to August 1999, 90 consecutive video-assisted Sympathicotomy for primary palmar hyperhidrosis either in isolation (n=56) or in combination with axillary and plantar hyperhidrosis (n=34) was performed. The mean follow-up period was 11.3 months. Attention was focused on patient’ s satisfaction, complications and morbidity. Results : Dry limbs were immediately achieved in all patients after surgery. There was no operative mortality and one case of transient Horner’ s syndrome was developed. Eight of 20 with plantar hyperhidrosis showed simultaneous improvement. The overall mean satisfaction rate was 92±2 percent with a median 93 percent improvement using a visual linear analogue scale from 0 (poor) to 100 percent (excellent). Only two patients were dissatisfied with the operative results due to compensatory hyperhidrosis (CH), which occurred in 25 patients and improved 20 patients within the follow-up period. Conclusions: The video-assisted thoracoscopic sympathicotomy with 2mm endoscope is a speedy and safe way of controlling hyperhidrosis with excellent cosmetic result while minimizing complication.

Comparison of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

이준,이지윤,최정석,성숙환 대한흉부외과학회 2019 Journal of Chest Surgery (J Chest Surg) Vol.52 No.3

Background: Uniportal video-assisted thoracoscopic surgery (VATS) has proven safe and effective for pulmonary wedge resection and lobectomy. The objective of this study was to evaluate the safety and feasibility of uniportal VATS segmentectomy by comparing its outcomes with those of the multiportal approach at a single center. Methods: The records of 84 patients who underwent VATS segmentectomy from August 2010 to August 2018, including 33 in the uniportal group and 51 in the multiportal group, were retrospectively reviewed and analyzed. Results: Anesthesia and operative times were similar in the uniportal and multiportal groups (215 minutes vs. 220 minutes, respectively; p=0.276 and 180 minutes vs. 198 minutes, respectively; p=0.396). Blood loss was significantly lower in the uniportal group (50 mL vs. 100 mL, p=0.013) and chest tube duration and hospital stay were significantly shorter in the uniportal group (2 days vs. 3 days, p=0.003 and 4 days [range, 1–14 days] vs. 4 days [range, 1–62 days], p=0.011). The number of dissected lymph nodes tended to be lower in the uniportal group (5 vs. 8, p=0.056). Conclusion: Our preliminary experience indicates that uniportal VATS segmentectomy is safe and feasible in well-selected patients. A randomized, prospective study with a large group of patients and long-term follow-up is necessary to confirm these results.

동맥관개존증 폐쇄술중 소개흉술과 흉강경수술의 비교

원용순 梨花女子大學校 醫科大學 醫科學硏究所 1998 EMJ (Ewha medical journal) Vol.21 No.4

Objectives : Surgical closure of patent ductus arterious(PDA) by lateral thoracotomy is con-sidered as a standard therapy. But large incision, muscle cutting and chest pain are problematic. So I used two less invasive techniques : minithoracotomy and video-assisted thoracoscopic surgery. I tried to compare the results of them. Methods : I reviewed the clinical records and operative reports of 22 children patients who were treated surgically between Jan. 19996 and Dec. 1996. Ten patients underwent Minithora-cotomy(MT) and twelve patients Video-assisted thoracoscopic surgery(VATS). All of them were used tithanium clipping for closure of PDA. Results : Both groups were similar in age, body weight, Echocardiographically estimated size of PDA and Qp/Qs. All procedures were performed uneventfully. Operative time averaged 104±26 minutes for MT versus 96±31 minutes for VATS. Mean hospital stay was 7.2±1.7 days for MT and 4.6±1.2 days for VATS(p<0.05}. Postoperative hoarseness was occured in one patient(MT group) but was transient. There was no case with residual shunt confirmed by echocardiography. Conclusion : Minithoracotomy and Video-assisted thoracoscopic surgery were as effective as lateral thoracotomy for closure of patent ductus arteriosus. Operative times were similar in two techniques but hospital stays were shorter in VATS group. Both MT and VATS techniques are effective and less invasive but I advocate VATS technique is more beneficial in terms of hospital stay and cosmetic aspect.

비디오 흉강경 수술로 완치된 월경성 객혈

조창범 ( Chang Beom Cho ),김동규 ( Dong Gyu Kim ),김창환 ( Chang Hwan Kim ),박지영 ( Ji Young Park ),이석원 ( Seok Won Lee ),장승훈 ( Seung Hun Jang ),정기석 ( Ki Suck Jung ),전선영 ( Sun Young Jun ),이재웅 ( Jae Woong Lee ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.1

Catamenial hemoptysis is a rare condition that`s characterized by recurrent hemoptysis occurring in association with menstruation, and this is associated with the presence of intrapulmonary or endobronchial endometrial tissue. The diagnosis of pulmonary endometriosis can be made according to a typical clinical history and with exclusion of other causes of recurrent hemoptysis. Treatment of pulmonary endometriosis can be medical or surgical; however, the optimal management of this condition is still a matter of debate. Medical therapy may be problematic, due to recurrence of symptoms despite hormonal ablation, and adverse effects from long-term hormone therapy can also be a problem. We report here on a case of pulmonary endometriosis in a 23-year-old woman who presented with hemoptysis that occurred during the first 3 days of menstruation, and this happened over a 4 month period. She was successfully treated by video-assisted thoracoscopic surgery (VATS). No more hemoptysis was noted during 12 months of follow-up.

폐암에서의 비디오 흉강경 폐엽절제술

김현구 대한의사협회 2012 대한의사협회지 Vol.55 No.12

Video-assisted thoracoscopic surgery (VATS) provides a new approach for treating early-stage lung cancer. VATS lobectomy has significant perioperative advantages such having as a lower rate of morbidity and being less immunosuppressive than open lobectomy, and it also provides a shorter recovery time, less postoperative pain, and faster resumption of a normal lifestyle. However,a clear definition of VATS lobectomy is lacking in the current literature. The generally accepted method of VATS lobectomy is from three to four incisions in number of port, 4.0 to 8.0 cm in utility length, and without rib spreading. However, there is still much debate on the role of VATS in lobectomy for the treatment of lung cancer. Concerns regarding safety, the extent of mediastinal lymph node dissection, and long-term survival have made some surgeons apprehensive of its validity for lung cancer. Nevertheless, recent data have shown that VATS lobectomy appears to have equivalent oncological results compared with open lobectomy for patients with early stage non-small cell lung cancer. With growing experience with VATS and development of thoracoscopic instrument, VATS can be beneficial to patients with early stage of lung cancer.

Management of Complications During Video-Assisted Thoracic Surgery Lung Resection and Lymph Node Dissection

최용수 대한심장혈관흉부외과학회 2021 Journal of Chest Surgery (J Chest Surg) Vol.54 No.4

Intraoperative events can occur during video-assisted thoracoscopic surgery (VATS) lobectomy due to unfavorable surgical anatomy, such as dense adhesions or calcifications around the pulmonary arteries. Troubleshooting intraoperative complications is essential for performing safe and successful VATS pulmonary resection and lymph node dissection. If continuous bleeding occurs or VATS does not proceed despite all measures, conversion to open thoracotomy should not be delayed.

제 11흉추 - 제 12흉추간 비디오 흉강경과 직접 측면 추체간 유합술 기구를 이용한 미세 침습 전방 추체간 유합술 - 증례 보고 -

서승표,심지훈,신태양,김준국,강창남 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.3

Study Design: Case report Objectives: To report a case of video-assisted thoracoscopic (VAT) minimally invasive anterior interbody fusion of the T11-T12 level using direct lateral interbody fusion (DLIF) devices. Summary of Literature Review: Interbody fusion of the thoracolumbar junction (especially T11-T12) is technically challenging from anterior, lateral, or posterior approaches. A VAT anterior interbody fusion approach using DLIF devices is a safe, minimally invasive alternative approach to the thoracolumbar spine. Materials and Methods: A 37-year-old male pedestrian was struck by a car sustaining fracture-dislocation at the T11-T12 level. The accident resulted in complete paraplegia of both lower extremities and multiple lower extremity fractures. A classical instrumented posterolateral fusion from T8 to L3 and staged VAT anterior interbody fusion at the T11-T12 level were performed. Results: At one year postoperatively, he was capable of independent ambulation using a wheelchair without back pain, and plain radiographs and CT scans showed a solid fusion at the T11-T12 level. Conclusions: VAT anterior interbody fusion using DLIF devices provides excellent access to the anterior spinal column with the added benefits of an improved field of view and can be a safe and effective alternative to open thoracotomy in the management of various thoracolumbar junction problems. 연구 계획: 증례 보고. 연구 목적: 제 11흉추-제 12흉추 골절-탈구에서 비디오 흉강경과 직접 측면 추체간 유합술 기구를 이용한 최소 침습 전방 추체간 유합술로 수술한 증례를 보고한다. 선행문헌의 요약: 흉요추 이행부, 특히 제 11흉추-제 12흉추간 추체간 유합술은 전방, 측방 또는 후방으로 수술하기에 기술적으로 어려움이 있다. 흉요추이행부에서 비디오 흉강경과 직접 측면 추체간 유합술 기구를 이용한 최소 침습 전방 추체간 유합술은 입원기간과 합병증을 줄일 수 있는 안전한 최소침습적 술식이다. 대상 및 방법: 37세 남자 환자로 보행자 교통사고로 인해 완전 하지 마비를 동반한 제 11흉추-제 12흉추 골절-탈구와 다발성 외상으로 내원하였다. 제 8 흉추부터 제 3요추까지 후방 기기고정술 및 후외방 유합술을 시행하였고, 단계적으로 제 11흉추-제 12흉추간 비디오 흉강경과 직접 측면 추체간 유합술기구를 이용한 최소 침습 전방 추체간 유합술을 시행하였다. 결과: 수술 1년 후, 환자는 통증 없이 단독으로 휠체어 거동이 가능하였고, 추시 단순 방사선 사진 및 컴퓨터 단층 촬영에서 만족할 만한 전방 유합을 확인하였다. 결론: 비디오 흉강경과 직접 측면 추체간 유합술 기구를 이용한 최소 침습 전방 추체간 유합술은 전방 추체로 효과적으로 접근할 수 있고, 시야확보가 용이하며 고식적인 개흉술을 대체할 안전하고 효과적인 술기라 사료된다.

Changes in Forced Expiratory Volume in 1 Second after Anatomical Lung Resection according to the Number of Segments

이선근,이승형,조상호,송재원,오창모,김대현 대한흉부외과학회 2021 Journal of Chest Surgery (J Chest Surg) Vol.54 No.6

Background: Although various methods are already used to calculate predicted post- operative forced expiratory volume in 1 second (FEV1) based on preoperative FEV1 in lung surgery, the predicted postoperative FEV1 is not always the same as the actual postoper- ative FEV1. Observed postoperative FEV1 values are usually the same or higher than the predicted postoperative FEV1. To overcome this issue, we investigated the relationship be- tween the number of resected lung segments and the discordance of preoperative and postoperative FEV1 values. Methods: From September 2014 to May 2020, the data of all patients who underwent anatomical lung resection by video-assisted thoracoscopic surgery (VATS) were gathered and analyzed retrospectively. We investigated the association between the number of re- sected segments and the differential FEV1 (a measure of the discrepancy between the pre- dicted and observed postoperative FEV1) using the t-test and linear regression. Results: Information on 238 patients who underwent VATS anatomical lung resection at Kyung Hee University Hospital at Gangdong and by DH. Kim for benign and malignant dis- ease was collected. After applying the exclusion criteria, 114 patients were included in the final analysis. In the multiple linear regression model, the number of resected segments showed a positive correlation with the differential FEV1 (Pearson r=0.384, p<0.001). After ad- justing for multiple covariates, the differential FEV1 increased by 0.048 (95% confidence inter- val, 0.023–0.073) with an increasing number of resected lung segments (R2=0.271, p<0.001). Conclusion: In this study, after pulmonary resection, the number of resected segments showed a positive correlation with the differential FEV1.