최소 침습 척추 수술의 과거, 현재 그리고 미래

박상민,홍재영,박시영,손은석,임수택,최소침습 척추치료 연구그룹 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.4

Study Design: Review article. Objectives: To introduce the past and present of minimally invasive spine surgery, as well as future developments. Summary of Literature Review: Spine surgery has evolved into a minimally invasive surgical procedure that requires skin incisions that are as small as possible. This has become a topic of interest for both patients and doctors, as it not only solves cosmetic problems by reducing skin incisions, but also reduces postoperative pain and complications by preserving as much normal tissue as possible while reducing blood loss, shortens the recovery period, and facilitates the return to normal life. At the same time, the surgical instruments required for minimally invasive surgery are being actively developed. Materials and Methods: Review of the relevant articles Results: The history of minimally invasive techniques is well described in the evolution of the surgical treatment of lumbar disc herniation. Minimally invasive lumbar discectomy began in the early 20th century, and many advances were made with the development of microscopes and tubular retractors. The development of endoscopes also led to the popularization and use of minimally invasive surgery. Minimally invasive surgery is also used in the thoracic and cervical spine, but many advances remain to be made in the lumbar spine. More recently, technologies such as navigation, robotics, and augmented reality have been developed and are helping to improve the safety of minimally invasive spine surgery. Conclusions: Minimally invasive spine surgery is rapidly evolving with recent technological advances. Advances in technology are expected to compensate for the limitations of minimally invasive surgery, and it is likely to become an alternative to traditional surgery for a variety of spinal diseases.

Minimally Invasive Surgery versus Open Surgery for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis

Neradi Deepak,Kumar Vishal,Kumar Sunil,Sodavarapu Praveen,Goni Vijay G.,Dhatt Sarvdeep Singh 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.2

Minimally invasive surgery (MIS) is being recommended over more invasive methods. MIS advantages are less time in the operating room, less blood loss, a shorter recovery time, and shorter length of stay. A systematic review and meta-analysis were performed using the literature from minimally invasive and open surgery for adolescent idiopathic scoliosis (AIS). We conducted this analysis to see whether MIS has advantages over traditional surgery. A systematic review was conducted using PubMed, Embase, and Scopus to find articles comparing minimally invasive and open surgery techniques for AIS patients. Data extraction and meta-analysis were completed. The primary data points collected were correction rate and functional outcomes, including perioperative and postoperative parameters. A total of six studies were included in the final analysis. The MIS group had 123 patients, and the open surgery group had 150 patients. The correction rate and functional outcomes favored the open surgery group with a mean difference of 4.60 (95% confidence interval [CI], 0.08 to 9.12) and 0.11 (95% CI, 0.04 to 0.17), respectively. The duration of surgery, blood loss, number of patients requiring transfusion, and analgesic requirements favored the MIS group with a significant difference. Open surgery is better than MIS in achieving a better correction rate and good functional outcomes. MIS is better over open surgery when perioperative parameters are considered.

식도암의 최소침습수술

나국주 ( Kook Joo Na ) 대한소화기학회 2007 대한소화기학회지 Vol.50 No.4

Minimally invasive surgery is now rapidly developing and becoming a standard surgical option in some fields. In the past, many thoracic surgeons were reluctant to adopt minimally invasive techniques in esophageal cancer surgery due to concern over the oncologic perspectives and technical difficulties. However, over the last few years, thoracic surgeons have progressively embraced the technical advancements and now many experienced centers have adopt minimally invasive surgery as a primary option for non-advanced esophageal cancer operations. In esophageal cancer surgery, the volume of operation performed in some hospital is closely related to the outcome of patients, and the experiences of surgical team play an important role in minimally invasive surgery. Minimally invasive esophageal surgery (MIES) has steep learning curves, also. The merits of MIES are as follows. The conventional esophageal cancer operation has two or triple incisions, resulting in high postoperative morbidity and mortality. However, postoperative complication in MIES became less frequent than conventional surgery. The patient`s satisfaction is high. Mid-term outcomes of MIES have been reported that it is safe and feasible in esophageal cancer and survival curves are similar to those of conventional surgery. Therefore, MIES is a valuable therapeutic modality for both esophageal cancer patients and thoracic surgeons. (Korean J Gastroenterol 2007;50:226-232)

Establishment of Minimally Invasive Thoracic Surgery Program

조종호 대한흉부외과학회 2021 Journal of Chest Surgery (J Chest Surg) Vol.54 No.4

The establishment of minimally invasive surgery is a complex and difficult task. Video-as- sisted thoracic surgery (VATS) refers to a minimally invasive surgical technique that rep- resents a less invasive approach to thoracic surgery using thoracoscopy. For lung cancer or esophageal cancer surgery, planning and establishing a team for minimally invasive surgery for the first time is not a simple task. Technical advances in surgical devices and the enhanced skill of surgeons are cornerstones of the development of minimally invasive surgery. Here, we review the meaning of minimally invasive thoracic surgery and discuss how to establish a team approach for VATS procedures.

단일통로 복강경수술

이우정 대한의사협회 2010 대한의사협회지 Vol.53 No.9

Minimally invasive surgery and laparoscopic surgery have been used for more than 30 years,and are now popular even for some malignant diseases. There have been two developments in technology; one is robotic surgery and the other is less minimally invasive surgery like natural orifice transluminal endoscopic surgery (NOTES) and single port laparoscopic surgery. NOTES, using the current platform of a conventional fiberscope and side channel instruments for surgery, suffers many limitations, including image quality, flexibility of the fiberscope, size of the side channel, and difficulty of closing the opening. Due to the above-mentioned limitations, single port laparoscopic surgery has many advantages over. This review aims to define single port laparoscopic surgery and describe its terminology and technology. To perform single port laparoscopic surgery efficiently, new instruments (e.g., a laparoscopic camera, ports, laparoscopic instruments) and combining other innovative methods into surgery are both helpful. Even though there have been many developments in laparoscopic cameras, ports, and laparoscopic instruments to enhance single port laparoscopic surgery, further improvements are needed. Motorized instruments or using a robotic platform in combination with single port laparoscopic surgery will be another way to overcome the limitations of current single port laparoscopic surgery. Single port laparoscopic surgery is a technique that has recently emerged, but will be performed in a wider range of surgical procedures based on developments in laparoscopic cameras, ports and laparoscopic instrument technology.

Advantages of laparoscopy in gynecologic surgery in elderly patients

Jaewon Na,Young Eun Chung,Il-Yeo Jang,Yoo-Young Lee,Tae-Joong Kim,Jeong-Won Lee,Byoung-Gie Kim,Chi-Son Chang,Chel Hun Choi 대한산부인과학회 2024 Obstetrics & Gynecology Science Vol.67 No.2

Objective Geriatric patients requiring gynecological surgery is increasing worldwide. However, older patients are at higher risk of postoperative morbidity and mortality, particularly cardiopulmonary complications. Laparoscopic surgery is widely used as a minimally invasive method for reducing postoperative morbidities. We compared the outcomes of open and laparoscopic gynecologic surgeries in patients older than 55 years.Methods We included patients aged >55 years who underwent gynecological surgery at a single tertiary center between 2010 and 2020, excluding vaginal or ovarian cancer surgeries were excluded. Surgical outcomes were compared between the open surgery and laparoscopic groups, with age cutoff was set at 65 years for optimal discriminative power. We performed linear or logistic regression analyses to compare the surgical outcomes according to age and operation type.Results Among 2,983 patients, 28.6% underwent open surgery and 71.4% underwent laparoscopic surgery. Perioperative outcomes of laparoscopic surgery were better than those of open surgery in all groups. In both the open and laparoscopic surgery groups, the older patients showed worse overall surgical outcomes. However, age-related differences in perioperative outcomes were less severe in the laparoscopic group. In the linear regression analysis, the differences in estimated blood loss, transfusion, and hospital stay between the age groups were smaller in the laparoscopy group. Similar results were observed in cancer-only and benign-only cohorts.Conclusion Although the surgical outcomes were worse in the older patients, the difference between age groups was smaller for laparoscopic surgery. Laparoscopic surgery offers more advantages and safety in patients aged >65 years. Objective Geriatric patients requiring gynecological surgery is increasing worldwide. However, older patients are at higher risk of postoperative morbidity and mortality, particularly cardiopulmonary complications. Laparoscopic surgery is widely used as a minimally invasive method for reducing postoperative morbidities. We compared the outcomes of open and laparoscopic gynecologic surgeries in patients older than 55 years. Methods We included patients aged >55 years who underwent gynecological surgery at a single tertiary center between 2010 and 2020, excluding vaginal or ovarian cancer surgeries were excluded. Surgical outcomes were compared between the open surgery and laparoscopic groups, with age cutoff was set at 65 years for optimal discriminative power. We performed linear or logistic regression analyses to compare the surgical outcomes according to age and operation type. Results Among 2,983 patients, 28.6% underwent open surgery and 71.4% underwent laparoscopic surgery. Perioperative outcomes of laparoscopic surgery were better than those of open surgery in all groups. In both the open and laparoscopic surgery groups, the older patients showed worse overall surgical outcomes. However, age-related differences in perioperative outcomes were less severe in the laparoscopic group. In the linear regression analysis, the differences in estimated blood loss, transfusion, and hospital stay between the age groups were smaller in the laparoscopy group. Similar results were observed in cancer-only and benign-only cohorts. Conclusion Although the surgical outcomes were worse in the older patients, the difference between age groups was smaller for laparoscopic surgery. Laparoscopic surgery offers more advantages and safety in patients aged >65 years.

Design of the Dexterous Manipulator for Minimally Invasive Surgery

Jong-Ha Chung,Ho-Seok Song,Jung-Ju Lee 한국과학기술원 인간친화 복지 로봇 시스템 연구센터 2004 International Journal of Assistive Robotics and Me Vol.5 No.2

  Minimally Invasive Surgery (MIS) is carried out in the chest, abdomen, spine and pelvis, by using a viewing scope and special surgical tools. Benefits of minimally invasive surgery are less pain, less need for post-surgical pain medication, less scarring and less likelihood for incisional complications. Since the late 1980"s, minimally invasive surgery has gained widespread acceptance because of these advantages. However there are significant disadvantages also, such as the limited usability of the minimal invasive techniques. The reasons are limited degree-of-freedom, reduced dexterity and the lack of tactile feeling. To overcome such disadvantages many researchers have endeavored to develop robotic systems. Even though some robot aided systems achieved success and commercialized, there still remain many thing to be improved. In this paper, the robotic system which can mimic whole motions of a human arm by adding additional DOF is presented. The suggested design is expected to provide surgeons with improved dexterity during minimally invasive surgery.

Minimally invasive radical hysterectomy and the importance of avoiding cancer cell spillage for early-stage cervical cancer: a narrative review

Atsushi Fusegi,Hiroyuki Kanao,Shiho Tsumura,Atsushi Murakami,Akiko Abe,Yoichi Aoki,Hidetaka Nomura 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.1

Radical hysterectomy is a standard surgery to treat early-stage uterine cervical cancer. The Laparoscopic Approach to Cervical Cancer (LACC) trial has shown that patients receiving minimally invasive radical hysterectomy have a poorer prognosis than those receiving open radical hysterectomy; however, the reason for this remains unclear. The LACC trial had 2 concerns: the learning curve and the procedural effects. Appropriate management of the learning curve effect, including surgeons’ skills, is required to correctly interpret the result of surgical randomized controlled trials. Whether the LACC trial managed the learning curve effect remains controversial, based on the surgeons’ inclusion criteria and the distribution of institutions with recurrent cases. An appropriate surgical procedure is also needed, and avoiding intraoperative cancer cell spillage plays an important role during cancer surgery. Cancer cell spillage during minimally invasive surgery to treat cervical cancer is caused by several factors, including 1) exposure of tumor, 2) the use of a uterine manipulator, and 3) direct handling of the uterine cervix. Unfortunately, these issues were not addressed by the LACC trial. We evaluated the results of minimally invasive radical hysterectomy while avoiding cancer cell spillage for early-stage cervical cancer. Our findings show that avoiding cancer cell spillage during minimally invasive radical hysterectomy may ensure an equivalent oncologic outcome, comparable to that of open radical hysterectomy. Therefore, evaluating the importance of avoiding cancer cell spillage during minimally invasive surgery with a better control of the learning curve and procedural effects is needed.

Solo (집도의 단독) 수술의 소개: 술기적 측면 및 초기 경험

이상철 대한내시경복강경외과학회 2016 Journal of Minimally Invasive Surgery Vol.19 No.4

Solo surgery is a practice in which a surgeon operates alone, without other surgical member’s assistance or cooperation, except for a scrub nurse and an anesthetist. Solo surgery at our institution is facilitated by several equipment, including Lone Star Retractor systems and a passive camera holder. The introduction of single-port laparoscopic surgery (SPLS) has dramatically increased the applicability of solo surgery, because SPLS reduces the number of surgical members participating in the surgery. A shortcoming of laparoscopic surgery is the indirect way of observing and manipulating. Solo surgery effectively eliminates this limitation by enabling operator-driven manipulation of the camera. Solo surgery is particularly advantageous in surgeries that are limited to a single quadrant, such as appendectomy, cholecystectomy, and herniorrhaphy, because they require less adjustment of the camera. However, its indications can be extended to include operations that involve multiple quadrants, such as various types of colectomies including total colectomy. In addition, solo open surgery can be performed with the aid of a larger retractor (i.e., the Bookwalter Retractor system). It appears that solo surgery can be performed by any surgeon who can perform SPLS competently and its indications can be extended, possibly after the development of supporting equipment.

로봇을 이용한 심장수술이 환자의 통증, 수면 및 자가간호수행에 미치는 영향

박수현,장인실 한국디지털정책학회 2019 디지털융복합연구 Vol.17 No.7

The purpose of this study was to know the difference in pain, sleep, self-care behavior in patients performed by sternotomy and robotic minimally invasive cardiac surgeries. The participants were 64 patients with sternotomy and 64 patients with minimal thoracotomy in heart valve surgeries at a tertiary hospital in Seoul. Data were analyzed using descriptive statistics, χ2 test, paired t-test. with SPSS/WIN(22.0). The participants with minimally invasive thoracotomy felt severe pain than the patients with thoracotomy at post operation day 2 & 5. The severe pain site were the surgical site in both groups. The participants with sternotomy had better sleep than minimally invasive thoracotomy patients. Self-care behavior was higher in the minimally invasive thoracotomy group. Therefore, despite the many advantages of robotic surgery such as rapid recovery and shortening of length of stay in hospital, accurate pain assessment and application of differentiated protocols are needed for the management of pain in the patients with robotic minimally invasive cardiac surgeries. In addition, a structured education program intervention is needed to improve comfort by considering gender, age, and method of operation. 본 연구는 로봇을 이용한 최소침습절개술 접근과 기존의 정중흉골절개술 접근을 이용한 심장판막수술환자를 대상으로 통증, 수면, 자가간호수행을 파악하고 이를 비교분석하기 위한 조사연구이다. 대상자는 서울시 일개 상급종합병원에서 심장수술을 시행한 대상자 중 정중흉골절개술군 64명, 최소침습절개술군 64명을 대상으로 하였다. 자료분석은 SPSS 22.0 프로그램을 이용하여 기술적 통계, χ2 검증, paired t-test를 시행하였다. 수술 후 2일째, 5일째 모두 통증은 로봇을 이용한 최소침습절개술군이 정중흉골절개술군에 비해 높았다. 통증발생부위는 두 군 모두 수술접근부위로 크게 나타났다. 수면은 수술 후 2일째 정중흉골절개술군에서 높게 나타났으며, 자가간호수행은 최소침습절개술군에서 높게 나타났다. 그러므로 로봇 수술의 재원기간 단축과 빠른 회복 등의 장점에도 불구하고 대상자의 통증관리를 위해 정확한 통증 사정 및 차별화된 프로토콜의 적용이 필요시 된다. 또한 성별, 연령 및 수술방법의 차이를 고려하여 안위를 증진시키기 위한 체계화된 교육 프로그램 중재가 요구되어진다.