1.Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Jun Seok LEE ; Dong Wuk SON ; Su Hun LEE ; Jong Hyeok LEE ; Young Ha KIM ; Sang Weon LEE ; Bu Kwang OH ; Soon Ki SUNG ; Geun Sung SONG ; Seong YI
Neurospine 2024;21(1):116-127
Objective:
This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery.
Methods:
We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed.
Results:
Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained.
Conclusion
RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.
2.Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Jun Seok LEE ; Dong Wuk SON ; Su Hun LEE ; Jong Hyeok LEE ; Young Ha KIM ; Sang Weon LEE ; Bu Kwang OH ; Soon Ki SUNG ; Geun Sung SONG ; Seong YI
Neurospine 2024;21(1):116-127
Objective:
This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery.
Methods:
We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed.
Results:
Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained.
Conclusion
RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.
3.Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Jun Seok LEE ; Dong Wuk SON ; Su Hun LEE ; Jong Hyeok LEE ; Young Ha KIM ; Sang Weon LEE ; Bu Kwang OH ; Soon Ki SUNG ; Geun Sung SONG ; Seong YI
Neurospine 2024;21(1):116-127
Objective:
This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery.
Methods:
We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed.
Results:
Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained.
Conclusion
RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.
4.Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Jun Seok LEE ; Dong Wuk SON ; Su Hun LEE ; Jong Hyeok LEE ; Young Ha KIM ; Sang Weon LEE ; Bu Kwang OH ; Soon Ki SUNG ; Geun Sung SONG ; Seong YI
Neurospine 2024;21(1):116-127
Objective:
This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery.
Methods:
We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed.
Results:
Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained.
Conclusion
RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.
5.Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Jun Seok LEE ; Dong Wuk SON ; Su Hun LEE ; Jong Hyeok LEE ; Young Ha KIM ; Sang Weon LEE ; Bu Kwang OH ; Soon Ki SUNG ; Geun Sung SONG ; Seong YI
Neurospine 2024;21(1):116-127
Objective:
This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery.
Methods:
We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed.
Results:
Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained.
Conclusion
RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.
6.Clinical characteristics and outcomes of injuries in agricultural and nonagricultural workers visiting the emergency department: a propensity-matched analysis
Jong Yeon KANG ; Sung Wook SONG ; Hansol HONG ; Woo Jeong KIM ; YoungJoon KANG ; Jeong Ho KANG ; Sung Kgun LEE ; Ji Hwan BU ; Seo Young KO ; Soo Hoon LEE
Clinical and Experimental Emergency Medicine 2024;11(1):68-78
Objective:
Agriculture is a hazardous industry. However, previous studies have focused on injuries to agricultural workers without comparison with injuries to nonagricultural workers. Therefore, we compared the clinical characteristics and outcomes of injuries reported at an emergency department (ED) between agricultural workers and nonagricultural workers.
Methods:
We established a prospective ED-based agricultural injury surveillance system at a tertiary university hospital. Adult patients visiting the ED for an injury were divided into farmer and non-farmer groups depending on their engagement with agriculture. Using an adjusted multivariate analysis and propensity score matching (age, sex, inhabitant, and insurance type), we compared the clinical characteristics and outcomes of injuries between the farmer and non-farmer groups.
Results:
In total, 38,556 injured adult patients (37,746 in the non-farmer group and 810 in the farmer group) were available for the unmatched sample analysis. The 1,620 matched subjects were equally classified after one-to-one nearest-neighbor propensity score matching. A multivariate logistic regression analysis of the unmatched sample revealed higher adjusted odds ratios (ORs) for intensive care unit admission (adjusted OR, 1.752; P=0.003) and overall surgery (adjusted OR, 1.870; P<0.001) in the farmer group. In contrast, univariate logistic regression analyses of the propensity score–matched sample found a higher OR in the farmer group only for overall surgery (OR, 1.786; P<0.001).
Conclusion
Injuries of agricultural workers had higher odds only of requiring surgery; differences in injury-related mortality between groups were not statistically significant in either the matched or unmatched sample analyses.
7.A Single-Center Experience of Robotic-Assisted Spine Surgery in Korea : Analysis of Screw Accuracy, Potential Risk Factor of Screw Malposition and Learning Curve
Bu Kwang OH ; Dong Wuk SON ; Jun Seok LEE ; Su Hun LEE ; Young Ha KIM ; Soon Ki SUNG ; Sang Weon LEE ; Geun Sung SONG ; Seong YI
Journal of Korean Neurosurgical Society 2024;67(1):60-72
Objective:
: Recently, robotic-assisted spine surgery (RASS) has been considered a minimally invasive and relatively accurate method. In total, 495 robotic-assisted pedicle screw fixation (RAPSF) procedures were attempted on 100 patients during a 14-month period. The current study aimed to analyze the accuracy, potential risk factors, and learning curve of RAPSF.
Methods:
: This retrospective study evaluated the position of RAPSF using the Gertzbein and Robbins scale (GRS). The accuracy was analyzed using the ratio of the clinically acceptable group (GRS grades A and B), the dissatisfying group (GRS grades C, D, and E), and the Surgical Evaluation Assistant program. The RAPSF was divided into the no-breached group (GRS grade A) and breached group (GRS grades B, C, D, and E), and the potential risk factors of RAPSF were evaluated. The learning curve was analyzed by changes in robot-used time per screw and the occurrence tendency of breached and failed screws according to case accumulation.
Results:
: The clinically acceptable group in RAPSF was 98.12%. In the analysis using the Surgical Evaluation Assistant program, the tip offset was 2.37±1.89 mm, the tail offset was 3.09±1.90 mm, and the angular offset was 3.72°±2.72°. In the analysis of potential risk factors, the difference in screw fixation level (p=0.009) and segmental distance between the tracker and the instrumented level (p=0.001) between the no-breached and breached group were statistically significant, but not for the other factors. The mean difference between the no-breach and breach groups was statistically significant in terms of pedicle width (p<0.001) and tail offset (p=0.042). In the learning curve analysis, the occurrence of breached and failed screws and the robot-used time per screw screws showed a significant decreasing trend.
Conclusion
: In the current study, RAPSF was highly accurate and the specific potential risk factors were not identified. However, pedicle width was presumed to be related to breached screw. Meanwhile, the robot-used time per screw and the incidence of breached and failed screws decreased with the learning curve.
8.Treatment Efficacy of Various Maneuvers for Lateral Canal Benign Paroxysmal Positional Vertigo With Apogeotropic Nystagmus: A Randomized Controlled Trial
Hyun Jin LEE ; Eun-Ju JEON ; Sungil NAM ; Seog-Kyun MUN ; Shin-Young YOO ; Seong Hyun BU ; Jin Woong CHOI ; Jae Ho CHUNG ; Seok Min HONG ; Seung-Hwan LEE ; Min-Beom KIM ; Ja-Won KOO ; Hyun Ji KIM ; Jae-Hyun SEO ; Seong-Ki AHN ; Shi Nae PARK ; Minbum KIM ; Won-Ho CHUNG
Clinical and Experimental Otorhinolaryngology 2023;16(3):251-258
Objectives:
The aim of this study was to determine the most effective treatment approach by comparing the impacts of various otolith reduction techniques in patients with apogeotropic lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV).
Methods:
We performed a multicenter randomized prospective study from January to December 2015, involving 72 consecutive patients with apogeotropic LC-BPPV. The patients were divided into three treatment groups: therapeutic head-shaking (group A), the Gufoni-Appiani maneuver (group B), and the cupulolith repositioning maneuver (CuRM; group C). Each group underwent evaluation and treatment up to the fourth week. Treatment success was defined as the disappearance of positional vertigo and nystagmus.
Results:
This study included 72 patients (49 male and 23 female), with a mean (±standard deviation) age of 55.4±13.5 years. The mean duration of vertigo experienced prior to treatment was 3.9±4.4 days. The mean latency and duration of nystagmus were 2.7±3.0 seconds and 47.9±15.8 seconds, respectively. The overall treatment frequency was 2.0±0.9. The number of treatments differed significantly among the three groups (P<0.05). After 4 weeks, the success rates for groups A, B, and C were 90.5%, 92.3%, and 100%, respectively. No significant difference was observed in the success rate across treatment methods and periods (P>0.05). However, CuRM was the only method with a 100% treatment success rate.
Conclusion
While no clear difference was observed among the three treatments for LC-BPPV, CuRM was found to be superior to the other approaches in the long term.
9.Comparative Analysis of Clinical Outcomes after Placement of Enhanced Monofocal, Monofocal, and Trifocal Intraocular Lenses
Journal of the Korean Ophthalmological Society 2023;64(1):25-34
Purpose:
To compare the clinical outcomes of patients given an enhanced monofocal intraocular lens (IOL) (Isopure; PhysIOL, Liege, Belgium), and monofocal, and trifocal IOLs.
Methods:
Patients who underwent cataract surgery with bilateral implantation of monofocal Vivinex IOLs, enhanced monofocal Isopure IOLs, and trifocal Panoptix IOLs were included. Three months postoperatively, the uncorrected distance visual acuity (UDVA), intermediate visual acuity (UIVA), and near visual acuity (UNVA), as well as the spherical equivalent (SE) were determined. Photic symptoms were explored via a questionnaire.
Results:
The postoperative SE and UDVA did not differ significantly among the three groups (p = 0.100 and 0.204 respectively). The mean UIVAs (logMAR) were 0.61 ± 0.14, 0.3 ± 0.1, and 0.14 ± 0.11 in the Vivinex, Isopure, and Panoptix groups respectively. The Isopure group exhibited a significantly better UIVA than the Vivinex group (p < 0.001) and the Panoptix group exhibited a significantly better UIVA than either the Vivinex or Isopure group (p = 0.002 and < 0.001 respectively). The mean UNVAs (logMAR) were 0.68 ± 0.16, 0.57 ± 0.19, and 0.17 ± 0.12 for the Vivinex, Isopure, and Panoptix groups respectively. There was no significant UNVA difference between the Vivinex and Isopure groups (p = 0.185) but the UNVA of the Panoptix group was significantly better than the UNVAs of the Vivinex and Isopure groups (both p < 0.001). There was no significant difference in photic symptoms between the Vivinex and Isopure groups (p = 0.980); however, the Panoptix group evidenced significantly more severe symptoms than did the other two groups (p = 0.021 and 0.042 respectively).
Conclusions
Enhanced monofocal Isopure IOL showed superior intermediate vision compared to Vivinex monofocal IOL, and inferior intermediate and near visual acuity compared Panoptix trifocal IOL, but with fewer photic symptoms.
10.Effectiveness and Usefulness of Bone Turnover Marker in Osteoporosis Patients: A Multicenter Study in Korea
Jun-Il YOO ; So Young PARK ; Deog-Yoon KIM ; Jeonghoon HA ; Yumie RHEE ; Namki HONG ; Jung-Taek KIM ; Hyon-Seung YI ; Bu Kyung KIM ; Young-Kyun LEE ; Yong-Chan HA ; Yun Kyung JEON ; Ha-Young KIM ; Seong Hee AHN ; Seongbin HONG ; Sang-Yeob LEE
Journal of Bone Metabolism 2023;30(4):311-317
Background:
This study aimed to investigate real-world data of C-terminal telopeptide (CTX), propeptide of type I collagen (P1NP), and osteocalcin through present multicenter clinical study, and retrospectively analyze the usefulness of bone turnover markers (BTMs) in Koreans.
Methods:
The study focused on pre- and post-menopausal patients diagnosed with osteoporosis and excluded patients without certain test results or with test intervals of over 1 year. The demographic data and 3 BTMs (CTX, P1NP, and osteocalcin) were collected. The patients were classified by demographic characteristics and the BTM concentrations were analyzed by the group.
Results:
Among women with no history of fractures, the levels of P1NP (N=2,100) were 43.544±36.902, CTX (N=1,855) were 0.373 ±0.927, and osteocalcin (N=219) were 10.81 ±20.631. Among men with no history of fractures, the levels of P1NP (N=221) were 48.498±52.892, CTX (N=201) were 0.370±0.351, and osteocalcin (N=15) were 7.868 ±10.674. Treatment with teriparatide increased the P1NP levels after 3 months in both men and women, with a 50% increase observed in women. Similarly, treatment with denosumab decreased the CTX levels after 3 months in both men and women, with a reduction of 50% observed in women.
Conclusions
The results of this study can contribute to the accurate assessment of bone replacement status in Koreans. We also provide the P1NP level in the Korean population for future comparative studies with other populations.

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