One-Year Surgical Outcomes and Quality of Life after Minimally Invasive Sling Procedures for the Treatment of Female Stress Urinary Incontinence: TVT SECUR® vs. CureMesh®

주영민,최진호,서주태 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.5

Purpose: We compared the efficacy and safety of two minimally invasive sling procedures used to treat female stress urinary incontinence (SUI), tension-free vaginal tape (TVT) SECUR® and CureMesh®, and assessed the 1-year surgical outcomes. Materials and Methods: Sixty women with SUI were assigned to undergo either the TVT SECUR (n=38) or CureMesh (n=22) procedures between April 2007 and June 2008. Patients were monitored via outpatient visits at 1 month, 3 months, and 1 year after surgery. The efficacy of these procedures was evaluated by the cough test or by a urodynamic study. At these postoperative visits, the patients also completed several questionnaires, including incontinence quality of life, patient’s perception of urgency severity, the scored form of the Bristol Female Lower Urinary Tract Symptoms, visual analog scale, and questions about perceived benefit, satisfaction, and willingness to undergo the same operation again. The objective cure rate was defined as no leakage during the cough test with a full bladder. The subjective cure rate was evaluated by self-assessment of goal achievement performed 1 year postoperatively. Results: The two groups were similar in preoperative characteristics and urodynamic parameters. The objective cure rates were similar between TVT SECUR and CureMesh (68.4% vs. 77.3%). All respondents reported improvement after surgery. There were no intra-operative complications. Conclusions: Our results showed that the TVT SECUR and CureMesh procedures are both safe and simple to perform and have no significant differences in efficacy. Comparative studies with long-term follow-up are warranted to determine the true efficacy of these procedures. Purpose: We compared the efficacy and safety of two minimally invasive sling procedures used to treat female stress urinary incontinence (SUI), tension-free vaginal tape (TVT) SECUR® and CureMesh®, and assessed the 1-year surgical outcomes. Materials and Methods: Sixty women with SUI were assigned to undergo either the TVT SECUR (n=38) or CureMesh (n=22) procedures between April 2007 and June 2008. Patients were monitored via outpatient visits at 1 month, 3 months, and 1 year after surgery. The efficacy of these procedures was evaluated by the cough test or by a urodynamic study. At these postoperative visits, the patients also completed several questionnaires, including incontinence quality of life, patient’s perception of urgency severity, the scored form of the Bristol Female Lower Urinary Tract Symptoms, visual analog scale, and questions about perceived benefit, satisfaction, and willingness to undergo the same operation again. The objective cure rate was defined as no leakage during the cough test with a full bladder. The subjective cure rate was evaluated by self-assessment of goal achievement performed 1 year postoperatively. Results: The two groups were similar in preoperative characteristics and urodynamic parameters. The objective cure rates were similar between TVT SECUR and CureMesh (68.4% vs. 77.3%). All respondents reported improvement after surgery. There were no intra-operative complications. Conclusions: Our results showed that the TVT SECUR and CureMesh procedures are both safe and simple to perform and have no significant differences in efficacy. Comparative studies with long-term follow-up are warranted to determine the true efficacy of these procedures.

Surgical manual of the Korean Gynecologic Oncology Group: classification of hysterectomy and lymphadenectomy

이마리아,최철훈,전이경,김윤환,이광범,이신화,심승혁,송용중,노주원,장석준,이종민 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.1

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncologic Group (KGOG) has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we focused on radical hysterectomy and lymphadenectomy, and we developed a KGOG classification for those conditions.

Surgical manual of the Korean Gynecologic Oncology Group: ovarian, tubal, and peritoneal cancers

전섭,이성종,임명철,송태종,배재만,김기동,이정윤,김상운,장석준,이종민 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.1

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncology Group has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we describe surgical procedure for ovarian, fallopian tubal, and peritoneal cancers.

Trauma surgery without proper compensation under the current Korean National Health Insurance System

Kyoungwon Jung,Yunjung Heo,John Cook-Jong Lee,Mijin Lee,Suni Son,Hee Suk Park,Joo-Ok Kim,Jeong Hee Lee 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.92 No.5

Purpose: This study aimed to evaluate the situations and problems of the current health insurance fees for trauma surgeries. Methods: We reviewed the medical records and billing data from trauma surgeries performed in the hospital from August 2012 to July 2014. The name and number of surgeries were investigated and the code and number of operations prescribed by surgeons were compared with the number of cases actually billed to insurance. In addition, the results returned by the Health Insurance Review & Assessment Services (HIRA) after deduction were investigated and compared to verify the insurance review findings. Results: During the study period, total 1,534 trauma surgical procedures were performed for a total of 253 trauma patients. Based on names, 1,092 procedures were performed; however, 442 cases (28.8%) could not be prescribed because of lack of proper insurance codes for the procedures. A total of 1,046.5 surgical procedures were prescribed by surgeons, adjusted by the insurance team, and finally billed to the HIRA; 162 bills were returned from the HIRA after rate reductions, corresponding to a reduction rate of 15.5%. The major reason for reduction was “fee criteria and limited number”. The compensation rate for billed surgical procedures was 84.5%. Conclusion: The high reduction and low compensation rate for trauma surgery under the current Korean National Health Insurance System need to be reviewed and improved. Furthermore, it is necessary to establish new criteria for surgical procedures fees for latest ones such as damage control surgery performed on severe trauma patients.

노인의 대퇴전자간 골절의 수술적 방법에 따른 임상적 특성 및 의료비용 비교

최미나 대한간호학회 간호행정학회 2007 간호행정학회지 Vol.13 No.2

Purpose: Clinical characteristics and medical cost were analyzed according to the surgical procedures for intertrochanteric fracture in aged patients to assess the appropriateness of treatment expense and to find possibility of reducing the medical cost. Method: Variable for the statistical analysis were; the clinical characteristics, medical cost according to the surgical procedures, the treatment success rate, the total medical expense, and the average expense per case. SAS Package Version 8.02. was used to analyze the relevant data. Results: Operative procedures differ significantly according to the gender and by the location of institution. Only significant clinical variables according to the operative procedure were duration of general anesthesia and amount of blood transfusion. Average cost per treatment was the highest in the bipolar hemiarthroplasty followed by the gamma nail and hip compressing screw. Average cost for bipolar hemiarthroplasty was significantly higher than other surgical procedures. Conclusions: The difference in hospital costs for treatment of intertrochanteric fracture originates from the utilized surgical procedures, mostly by the materials used. The method of surgical treatment should be carefully determined by the purpose of the surgery, in order to improve the quality of medical care and also to reduce the hospital cost.

Surgical management of the postoperative complications of hepato-pancreato-biliary surgery

Eduardo Javier Houghton,Juan Santiago Rubio 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.4

Gastrointestinal surgery is a vast field with many types of procedures, of which hepato-pancreato-biliary (HPB) operations are among the most frequently performed worldwide. Several complications of HPB surgery may occur. Most of these complications, such as wound infection, bleeding, abdominal wall eventrations, and intestinal obstruction, also occur with other procedures. This review analyzes surgical management-related complications associated with HPB surgery, including pancreatic fistula, bile leakage, biliary stenosis, and bile duct damage. Most of the complications of HPB surgery can be managed conservatively or with minimally invasive procedures. Nevertheless, surgical management still plays an important role.

새로운 의료시술의 도입과 임상적용 시의 윤리적 절차

강명신,이윤성,최보문,이동수,이상무,이선희,구영모,박재현,이일학,박지용,고윤석 한국의료윤리학회 2013 한국의료윤리학회지 Vol.16 No.1

Medical care largely depends on developments of medical sciences and technologies. Development of innovative medical procedure have to be based on medical evidence. And ethical climate among individual physicians, academic societies, specialists' organization, and healthcare institution which applies the procedure is as much critical as the ethical stance of the developer. Therefore, it is necessary to make decisions on clinical application and evaluation, social costs and benefits, reimbursement through rational procedure and standards taking into account issues like medical evidence and conflict of interests. Especially, in the case of innovative surgical and surgico-medical procedure, the adoption has almost been up to non-formal studies until recently. Formal review process based on basic principles of biomedical research ethics and evidence-based medicine, is to be proposed for development of innovative surgical and medical procedures. And this process is to be an integral part of biomedical technology assessment and ethical regulation. This paper suggests an ethical guideline for ethical review and evaluation of a new medical procedure from its initial attempt to clinical application. Though focused on innovations, this suggested guideline is also applicable to a new medical procedure. The paper consists of four parts. Firstly, it outlines the general discussion about surgical innovations from the ethical viewpoint. Secondly, prior researches about the need of guideline are reviewed. Thirdly, under this background, basic principles for process of review and evaluation, and fourthly, the very process is proposed. Lastly, the further suggestions in connection with health care policy are given.

Surgical management of the postoperative complications of hepato-pancreato-biliary surgery

Eduardo Javier Houghton,Juan Santiago Rubio 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.4

Gastrointestinal surgery is a vast field with many types of procedures, of which hepato-pancreato-biliary (HPB) operations are among the most frequently performed worldwide. Several complications of HPB surgery may occur. Most of these complications, such as wound infection, bleeding, abdominal wall eventrations, and intestinal obstruction, also occur with other procedures. This review analyzes surgical management-related complications associated with HPB surgery, including pancreatic fistula, bile leakage, biliary stenosis, and bile duct damage. Most of the complications of HPB surgery can be managed conservatively or with minimally invasive procedures. Nevertheless, surgical management still plays an important role.

Comparison of surgical outcomes of intracorporeal hepaticojejunostomy in the excision of choledochal cysts using laparoscopic versus robot techniques

Lee, Hongeun,Kwon, Wooil,Han, Youngmin,Kim, Jae Ri,Kim, Sun-Whe,Jang, Jin-Young The Korean Surgical Society 2018 Annals of Surgical Treatment and Research(ASRT) Vol.94 No.4

<P><B>Purpose</B></P><P>Increasing surgical expertise in minimally invasive surgery has allowed laparoscopic surgery to be performed in many abdominal surgeries. Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy are challenging and sophisticated surgeries because of the difficult anastomosis. Recent advances in robotic surgery have enabled more delicate and precise movements, and Endowrist instruments allow for securing sutures during anastomosis. This study aimed to compare surgical outcomes of laparoscopic and robotic hepaticojejunostomy in choledochal cyst excision.</P><P><B>Methods</B></P><P>Sixty-seven patients who underwent laparoscopic or robotic-hybrid choledochal cyst excision from 2004 to 2016 were retrospectively analyzed and compared. In robotic surgery, dissection was performed laparoscopically, and hepaticojejunostomy was performed using a robotic platform.</P><P><B>Results</B></P><P>The mean operative time was significantly longer in robotic surgery than in laparoscopic surgery (247.94 ± 54.14 minutes <I>vs</I>. 181.31 ± 43.06 minutes, P < 0.05). The mean estimated blood loss (108.71 ± 15.53 mL <I>vs</I>. 172.78 ± 117.46 mL, respectively, P = 0.097) and postoperative hospital stay (7.33 ± 2.96 days <I>vs</I>. 6.22 ± 1.06 days, P = 0.128) were comparable between procedures. Compared to the laparoscopic approaches, robotic surgery had significantly less short-term complications (22.4% <I>vs</I>. 0%, P = 0.029). There were more biliary leakage (n = 7, 14.3%) observed during the first 30 days after surgery in laparoscopy while none were observed in the robotic method.</P><P><B>Conclusion</B></P><P>Robotic surgery allow for more precise and secure sutures during anastomosis thereby reducing biliary complications. With expanding knowledge and expertise, robotic surgery may offer more advantages over laparoscopy in the era of minimally invasive surgery.</P>

A practical approach to nasal reconstruction in Asian patients

Koh, In Suk,Sun, Hook Korean Cleft Palate-Craniofacial Association 2021 Archives of Craniofacial Surgery Vol.22 No.5

Background: The study aimed to evaluate nasal reconstruction techniques customized for Asians. The currently available nasal reconstruction guidelines are based on Caucasian patients, and their applicability is limited in Asian patients due to differences in anatomical and structural features. Methods: A retrospective analysis was performed of the medical records of 76 patients who underwent nasal reconstruction at a single center between January 2010 and June 2020. A comprehensive evaluation was conducted of patients' baseline demographics and clinical characteristics, including age, sex, medical history, defect size and location, reconstructive procedure, pathological diagnosis, postoperative complications, and recurrence. Results: In 59 cases (77%), nasal defects resulted from tumor ablation, and the remaining 17 cases involved post-traumatic (20%) and infection-induced (3%) tissue damage. The most common defect location was the alae, followed by the sidewalls, tip, and dorsum. Forehead flaps were the most commonly used reconstructive technique, followed by nasolabial advancement flaps, rotation flaps, and skin grafts. Each procedure was applied considering aspects of structural anatomy and healing physiology specific to Asians. Complications included nasal deformity, hypertrophic scarring, secondary infection, and partial flap necrosis, but no cases required additional surgical procedures. Tumors recurred in two cases, but tumor recurrence did not significantly affect flap integrity. Conclusion: Nasal reconstruction techniques applied considering Asians' facial features resulted in fewer postoperative complications and higher patient satisfaction than the approaches that are currently in widespread use. Therefore, this study is expected to serve as an essential reference for establishing treatment guidelines for nasal reconstruction in Asians.