Browsing by Author "Chuang, Shu-Hung"

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Is routine single-incision laparoscopic cholecystectomy feasible? A retrospective observational study
(2015-08-01)
Chuang, Shu-Hung
;
Yang, Wen-Jui
;
Chang, Chih-Ming
;
Lin, Chih-Sheng
;
Yeh, Meng-Ching
BACKGROUND: Single-incision laparoscopic cholecystectomy (SILC) has been shown to be safe for uncomplicated gallbladder diseases. Routinely applying SILC is debatable. METHODS: Two hundred SILCs were performed with single-incision multiple-port longitudinal-array and self-camera techniques. RESULTS: Eighty-eight (44%) procedures were scheduled for complicated diseases. The routine group had a higher comorbidity rate, a lower preoperative endoscopic retrograde cholangiopancreatography rate, a higher intraoperative cholangiography rate, a higher proportion of complicated gallbladder diseases, shorter operative time, more intraoperative blood loss, and lower postoperative pethidine dose than the selective group (the first 73 patients). The conversion and complication rates showed no statistical difference. It took fewer cases but longer time to pass the learning phase of SILC for complicated gallbladder diseases. The multivariate analysis showed that male sex and complicated gallbladder diseases were associated with a higher procedure conversion rate, and increased patient age was related to a higher complication rate. CONCLUSIONS: Routine SILC for benign gallbladder diseases is feasible in the experienced phase. Practicing SILC for uncomplicated gallbladder diseases helps to achieve competence in this technique for complicated diseases. (C) 2015 Elsevier Inc. All rights reserved.
Single-Incision Laparoscopic Common Bile Duct Exploration with Conventional Instruments: an Innovative Technique and a Comparative Study
(2014-04-01)
Chuang, Shu-Hung
;
Chen, Pai-Hsi
;
Chang, Chih-Ming
;
Tsai, Yung-Fa
;
Lin, Chih-Sheng
Single-incision laparoscopic surgery developed rapidly in recent years. We introduce an innovative technique: single-incision laparoscopic common bile duct exploration (SILCBDE) with conventional instruments. A retrospective comparison between SILCBDE and standard laparoscopic common bile duct exploration (LCBDE) was analyzed. Thirty-four patients who underwent LCBDE for choledocholithiasis in a period of 17 months were enrolled. Seventeen standard LCBDEs and 17 SILCBDEs were attempted. Simultaneous cholecystectomies were performed. The stone clearance rate was 94.1 % (16 patients) in the standard LCBDE group and 100 % in the SILCBDE group. There was no statistical difference in demographic distribution, clinical presentations, and operative results between the two groups, except the SILCBDE group had a higher rate of acute cholecystitis than the standard LCBDE group (76.5 vs. 35.3 %; p < 0.05). One procedure (5.9 %) in the SILCBDE group was converted to a four-incision transcystic LCBDE. The complication rate was 11.8 % (two patients) in the standard LCBDE group and 5.9 % (one patient) in the SILCBDE group. The average follow-up period was 4.2 months. SILCBDE is as safe and efficacious as standard LCBDE in experienced hands. Choledochoscope manipulation and bile duct repair are the key skills. Long-term follow-up and further prospective randomized trials are anticipated.
Single-incision laparoscopic surgery for biliary tract disease
(2016-01-14)
Chuang, Shu-Hung
;
Lin, Chih-Sheng
;
生物科技學系
;
Department of Biological Science and Technology
Single-incision laparoscopic surgery (SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecystectomy (SILC) has been the most frequently studied SILS to date. Hundreds of studies on SILC have failed to present conclusive results. Most randomized controlled trials (RCTs) have been small in scale and have been conducted under ideal operative conditions. The role of SILC in complicated scenarios remains uncertain. As common bile duct exploration (CBDE) methods have been used for more than one hundred years, laparoscopic CBDE (LCBDE) has emerged as an effective, demanding, and infrequent technique employed during the laparoscopic era. Likewise, laparoscopic biliary-enteric anastomosis is difficult to carry out, with only a few studies have been published on the approach. The application of SILS to CBDE and biliary-enteric anastomosis is extremely rare, and such innovative procedures are only carried out by a number of specialized groups across the globe. Herein we present a thorough and detailed analysis of SILC in terms of operative techniques, training and learning curves, safety and efficacy levels, recovery trends, and costs by reviewing RCTs conducted over the past three years and two recently updated meta-analyses. All existing literature on single-incision LCBDE and single-incision laparoscopic hepaticojejunostomy has been reviewed to describe these two demanding techniques.
Single-incision vs three-incision laparoscopic cholecystectomy for complicated and uncomplicated acute cholecystitis
(2013-11-21)
Chuang, Shu-Hung
;
Chen, Pai-Hsi
;
Chang, Chih-Ming
;
Lin, Chih-Sheng
;
生物科技學系
AIM: To compare the clinical outcome of single-incision laparoscopic cholecystectomy (SILC) and three-incision laparoscopic cholecystectomy (3ILC) for acute cholecystitis. METHODS: From July 2009 to September 2012, 136 patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital. One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes, straight instruments, and conventional ports. Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded. The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings. Patient demog-raphy, clinical data, operative results and complications were recorded and analyzed. RESULTS: Fifty patients with gangrenous cholecystitis, gallbladder empyema, or hydrops were classified as the complicated group, and 58 patients with acute cholecystitis were classified as the uncomplicated group. Twenty-three (46.0%) of the patients in the complicated group (n = 50) and 39 (67.2%) of the patients in the uncomplicated group (n = 58) underwent SILC; all others underwent 3ILC. The postoperative length of hospital stay (PLOS) was significantly shorter in the SILC subgroups than the 3ILC subgroups (3.5 +/- 1.1 d vs 4.6 +/- 1.3 d, P < 0.01 in the complicated group; 2.9 +/- 1.1 d vs 3.7 +/- 1.4 d, P < 0.05 in the uncomplicated group). The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups, but the difference reached statistical significance only in the uncomplicated group (37.41 +/- 0.56. vs 37.80 +/- 0.72., P < 0.05 on postoperative day 1; 37.10 +/- 0.43. vs 37.57 +/- 0.54., P < 0.01 on postoperative day 2). The operative time, estimated blood loss, postoperative narcotic use, total length of hospital stay, conversion rates, and complication rates were similar in both SILC and 3ILC subgroups. The complicated group had longer operative time (122.2 +/- 35.0 min vs 106.6 +/- 43.6 min, P < 0.05), longer PLOS (4.1 +/- 1.3 d vs 3.2 +/- 1.2 d, P < 0.001), and higher conversion rates (36.0% vs 19.0%, P < 0.05) compared with the uncomplicated group. CONCLUSION: SILC is safe and efficacious for patients with acute cholecystitis. The main benefit is a faster recovery than that achieved with 3ILC. (C) 2013 Baishideng Publishing Group Co., Limited. All rights reserved.
Spacer-enhanced chymotrypsin-activated peptide-functionalized gold nanoparticle probes: a rapid assay for the diagnosis of pancreatitis
(2014)
Yeh, Fang-Yuan
;
Tseng, I-Hua
;
Chuang, Shu-Hung
;
Lin, Chih-Sheng
;
生物科技學系
Pancreatitis is the inflammation of the pancreas. Chymotrypsin, an indicator of pancreatic function, could serve as a biomarker for the diagnosis of pancreatitis. A gold nanoparticle (AuNP)-based fluorescence assay was fabricated in this study to assay the activity of chymotrypsin. Peptides labeled with fluorophores were conjugated onto AuNPs as a chymotrypsin-activated peptide-functionalized AuNP probe (AuNPs-peptide probe). The detection sensitivity of the AuNPs-peptide probe toward proteolytic activity was significantly increased by using spacer-enhanced peptides with specifically designed lengths and charges. The limit of detection of the designed AuNPs-peptide probe decreased, enabling detection at the pM level within a 15 min detection time. The AuNPs-peptide probe was used to evaluate chymotrypsin activity as an indicator of acute pancreatitis (AP) in a mouse model induced by cerulein challenge. The fecal chymotrypsin activity in cerulein-induced AP mice was significantly lower than that observed in controls. This is the first study to use an AuNPs-peptide probe for the diagnosis of pancreatitis using fecal specimens.