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Ultrasonically Activated Shears를 이용한 갑상선 수술에 대한 전향적 연구
김완욱,허성모,김성훈,이세경,임혜인,최재혁,김상민,이정언,김정한,김지수,남석진,양정현,최준호,Wan Wook Kim,M.D.,Sung Mo Hu,M.D.,Sung Hoon Kim,M.D.,Se-Kyung Lee,M.D.,Hye In Lim,M.D.,Jae Hyuck Choi,M.D.,Sangmin Kim,Ph.D.,Jeong Eon Lee,M.D.,Jung 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.2
Purpose: Adequate hemostasis in thyroidectomy is important to reduce postoperative complications including bleeding and hematoma. The object of this study was to evaluate the utility of thyroidectomy using ultrasonically activated shears. Methods: This was a prospective randomized controlled study. It was conducted on 95 patients who underwent total thyroidectomy between January and March 2009. Patients were divided into two groups according to operation method used: group A (n=49) underwent total thyroidectomy using ultrasonically activated shears, group B (n=46) involved the conventional clamp and tie maneuver. Comparisons included operation time, drain amount, hospitalization, postoperative complications and off-thyroglobulin. Results: The two groups had no significant differences regarding drain amount, hospitalization, postoperative complications and off-thyroglobulin. Operation time was statistically shorter in group A than group B (96.6±22.7 min vs 114.6±24.3 min) (P=.00). Conclusion: Thyroidectomy using ultrasonically activated shears reduces operation time significantly, and enables a complete and safe operation without postoperative complications. We recommend the use of ultrasonically activated shears in thyroidectomy. (Korean J Endocrine Surg 2009;9:69-73)
김완욱(Wan Wook Kim),허성모(Sung Mo Hur),김성훈(Sung Hoon Kim),이세경(Se Kyung Lee),김상민(Sangmin Kim),오영륜(Young Lyun Oh),최준호(Jun-Ho Choe),이정언(Jeong Eon Lee),김정한(Jung-Han Kim),남석진(Seok Jin Nam),양정현(Jung-Hyun Yang) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.3
Purpose: Follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC) are two main subtypes of well-differentiated thyroid cancer. Sometimes FTCs present more aggressive features such as vascular invasion. The object of this study was to investigate the clinicopathologic features, prognostic factors and treatment outcome of FTC. Methods: This retrospective study enrolled 91 patients diagnosed with FTC between November 1994 and October 2008. The clinicopathologic characteristics, treatment outcome and follow up data were analyzed. Results: The median follow-up (f/u) period was 76.1 months. Distant metastases at the time of diagnosis were detected in 12 patients. During the f/u period, one local recurrence and 4 distant metastases developed. Local recurrence or distant metastasis were noticed in 12 out of 19 patients with widely invasive type and 5 out of 36 patients with minimally invasive type with vascular invasion were also noted. The median times to local recurrence or distant metastasis were 59.0 and 34.2 months, respectively. On analysis, according to the clinocopathologic factors, presence of vascular invasion, extrathyroidal extension, invasion to structure, incomplete excision and pathological classification were independent prognostic factors for recurrence or distant metastasis. Disease specific mortality was seen in one patient. Conclusion: This study shows that aggressive treatments such as total thyroidectomy followed by radioiodine therapy and close follow-up of patients with minimally invasive type with vascular invasion and widely invasive type of FTC should be considered due to the chance of local recurrence and distant metastasis.
갑상선 수술에서 피부 전극을 이용한 신경모니터링의 실제적인 적용
김완욱(Wan Wook Kim),김지건(Ji Gun Kim) 대한신경모니터링학회 2023 Journal of Neuromonitoring & Neurophysiology Vol.3 No.2
Preservation of the recurrent laryngeal nerve during thyroid surgery is crucial for preserving the patient's quality of life after surgery. It is still considered standard procedure to visually identify the recurrent laryngeal nerve and carefully dissect it in order to preserve the nerve. However, due to the numerous advantages of neuromonitoring, its application in thyroid surgery is gradually increasing. Despite the advantages of neuromonitoring, electromyography tubes could not be used in most thyroid surgeries because they were not covered by insurance. Recently, there has been active research conducted on neuromonitoring using needle electrodes or skin electrodes as alternatives to electromyography (EMG) tubes. In this review, we will examine the practical clinical application of recent neuromonitoring techniques that utilize skin electrodes.
유방암 환자의 감시림프절 생검술에서 발견되는 고립종양세포의 의미
김균지(Gyunji Kim),최재혁(Jae Hyuck Choi),김완욱(Wan Wook Kim),이세경(Se Kyung Lee),임혜인(Hye In Lim),조은윤(Eun Yoon Cho),이정언(Jeong Eon Lee),남석진(Seok Jin Nam),양정현(Jung-Hyun Yang) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.6
Purpose: Sentinel lymph node (SLN) biopsy has replaced unnecessary axillary dissection in breast cancer surgery except when the nodes are positive for macrometastasis. But guidelines for isolated tumor cells (ITCs) found in SLNs has not yet been established and further study is ongoing. The goal of this study was to consider the implication of the isolated tumor cells found in the SLNs of Korean breast cancer patients. Methods: Between September 2003 and March 2008, 985 primary breast cancer patients underwent SLN biopsy. On reviewing the medical records, 81 patients were found to have ITCs in SLNs without macrometastasis or micrometastasis. ITCs were detected by serial sectioning and immunohistochemistry. Results: The mean number of detected SLNs was 3.5±1.7. Thirty three patients had multifocally distributed ITCs and 9 had ITCs in multiple SLNs whose N stage was N0 (i+). Completion axillary dissection has been performed in 9 patients and 3 of them (33.3%) finally were found to be N1 or N1mi. Conclusion: The characteristics of ITCs are not clear yet and their prognostic value is still under investigation. Until the significance of ITCs found in SLNs become definite, axillary dissection should be more aggressively considered.
갑상선 전절제술 및 중앙경부 림프절 박리술 후 발생한 유미누출: 3예 증례보고
황승욱·,최향희·,김완욱·,박호용·,정진향,Seung Ook Hwang,Hyang Hee Choi,Wan Wook Kim,Ho Yong Park,Jin Hyang Jung 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.3
Chyle leakage is a rare complication of surgery for thyroid cancer that generally develops after lateral neck dissection. Here, we describe chyle leakages experienced after central neck dissection (CND). A total of 615 patients with thyroid cancer were treated by total thyroidectomy with CND between Jan 2012 and Dec 2012 at our facility, and three (0.49%) developed chyle leakages. The amounts of leakage were all less than 100 ml/day. One patient was resolved with conservative management, while the others were treated with conservative treatment and fibrin glue injection in chylous lymphocele. Chyle leakage after CND is very uncommon, and most cases involve minor leakage. Fibrin glue could be a treatment option for chyle leakage following CND.
허성모(Sung Mo Hur),김성훈(Sung Hoon Kim),이세경(Se Kyung Lee),김완욱(Wan Wook Kim),최재혁(Jae Hyuck Choi),김상민(Sangmin Kim),임소영(So Young Lim),변재경(Jai Kyung Pyon),문구현(Goo Hyun Mun),최준호(Jun-Ho Choe),이정언(Jeong Eon Lee) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.3
Purpose: The aim of this study was to evaluate the usefulness of sentinel lymph node (SLN) biopsy in the treatment of primary melanoma. Methods: Fifty-one cases that were diagnosed as malignant melanoma of the skin without clinical evidence of regional lymph node metastasis and underwent SLN biopsy at Samsung Medical Center were analyzed retrospectively. A lymphoscintigraphy with peritumoral injection of radionuclide was performed preoperatively. SLNs were identified using a hand-held gamma probe and by methylene blue dye injection intraoperatively. Results: Twenty patients (39%) had metastasis in the SLN and they underwent immediate complete radical dissection of the nodal basin. Among the 20 patients who had SLN metastasis, additional metastatic lymph nodes were detected in 5 patients after the complete lymph node dissection. When several clinico-pathologic parameters such as gender, age, primary tumor location, draining nodal basin, tumor depth and size of tumor were compared between SLN positive group and negative group, there was a significant difference in the mean thickness of melanoma between SLN (+) group (5±2.9 ㎜) and SLN (?) group (4.5±5.0 ㎜) (P<0.05). In the same way, as the thickness of melanoma increased, positive SLN were detected more frequently (P<0.05). Recurrences occurred in 18 patients (35.3%) during the follow-up period, but only one case in 31 patients with negative SLN recurred at the SLN basin without evidence of distant or loco-regional recurrence (false negative rate 4.8%). Lymphedema of extremity developed in 9 patients who underwent complete radical lymph node dissection and 2 patients who underwent only SLN biopsy had a very mild-form lymphedema. Conclusion: SLN biopsy in the treatment of cutaneous melanoma is a safe, useful and feasible method to identify status of regional lymph node with low false negative rates and low complications.
양측 액와유륜부 접근법을 이용한 무배액관 로봇 또는 내시경하 갑상선 절제술의 안정성에 대한 예비연구
문소향(So Hyang Moon),전영산(Young San Jeon),김완욱(Wan Wook Kim),강수환(Su Hwan Kang),정영주(Young Ju Jeong),최정은(Jung Eun Choi),조지형(Ji hyoung Cho) 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.2
Purpose: The aim of this study was to evaluate the safety of robotic or endoscopic thyroidectomy via bilateral axillo-breast approach (BABA) without a drainage procedure. Methods: A total of 64 patients who underwent robotic or endoscopic thyroidectomy via BABA without a close suction drain between February and March 2012 were enrolled. We checked postoperative symptoms or signs including change of vital signs, dyspnea, swelling or fluctuation of anterior chest and neck and compression symptoms at 1, 6, 24, and 48 hours and 1 month after surgery. Postoperative ultrasonography was performed in patients with at least one or more postoperative symptoms or signs in order to confirm hematoma or fluid collection. Results: None of the enrolled patients had dyspnea or change of vital signs. Two of 64 patients had swelling, 1 of 64 patients had fluctuation on the anterior chest, and 1 of 64 patients had compression symptoms. Fluid collection was confirmed in 2 of 4 of the above mentioned patients and the collected fluid was aspirated. The amounts of aspirated fluid were 25 mL and 8 mL. Thereafter, the follow up ultrasonography showed no more fluid collection in all patients. In addition, we rechecked the above mentioned symptoms or signs at 1 month after surgery; none of the enrolled patients had symptoms or signs. Conclusion: Robotic or endoscopic thyroidectomy via BABA without a closed suction drain shows no serious seroma or hematoma collection. Therefore, we expect that robotic or endoscopic thyroidectomy via BABA without a closed suction drain can reduce the pain, discomfort or longer hospital stay as a result of closed suction drain using this method.
박종현 ( Jong Hyun Park ),박성환 ( Sung Hwan Park ),김백선 ( Paek Sun Kim ),이준욱 ( Joon Wook Lee ),유완희 ( Wan Hee Yoo ),주영실 ( Yeong Shil Joo ),이신석 ( Shin Seok Lee ),김완욱 ( Wan Uk Kim ),민준기 ( Jun Ki Min ),홍연식 ( Ye 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.3
Dermatomyositis is a clinical entity characterized by a distinctive cutaneous rash and inflammatory myopathy. In this disorder, the pneumomediastinum is quite a rare complication and is assumed to result from air leakage due to vasculitis, lung fibrosis or rarely after bronchoscopic lung biopsy and pulmonary function test. We describe patient with dermatomyositis who developed pneumomediastinum, pneumothorax and massive subcutaneous emphysema after pulmonary function test. She died due to respiratory failure. We think that careful observation is required in performing PFT in dermatomyositis patients with presumed interstitial lung diseases.