ABSTRACT
Digital intelligent hepatobiliary surgery has evolved over decades.It has experienced an evolution course from digital virtual human technology to the establishment of a quality-controlled and homogeneous three-dimensional visualization system for precision diagnosis and treatment of diseases, from three-dimensional visualization to the clinical transformation of digital intelligent technology and changes in the diagnosis and treatment model, from empirical diagnosis of diseases to the application of deep learning for the intelligent diagnosis and treatment of diseases, from empirical surgery to real-time multi-modal image guidance during surgery, and from the morphological diagnosis of tumors to accurate diagnosis from molecular imaging.During the whole process, only through continuous innovation in research, theory and technology can the "life" of digital intelligent surgery be endowed with new vitality.In the future, the definition of tumor boundary from the molecular and cellular levels and the early diagnosis and treatment of liver tumor through the functional visualization of key molecules will have significant clinical value for changing the prognosis of liver cancer.In addition, in order to realize intelligent navigation for hepatectomy and break through the technical bottleneck, it is of great clinical significance to develop an intelligent robot real-time navigation hepatectomy system with automatic navigation technology, machine learning intelligent planning technology and multimodal image fusion technology.This provides unprecedented opportunities and challenges for the development of digital intelligent hepatobiliary surgery.
ABSTRACT
Digital intelligent diagnostic and treatment technology is a novel technology which is based by combining modern medicine with digitalized and intelligent high-tech to form a multidisciplinary and multi-knowledge domain. This technology plays an important role in areas including precision diagnosis, preoperative planning and surgical navigation. Its core technologies are: (1) quality control research on high-quality CT imaging data acquisition; (2) quality control and homogenization research on three-dimensional (3D) reconstruction; (3) high-quality 3D printed physical models; (4) virtual reality 3D simulation platform; (5) molecular fluorescence imaging to define tumor boundaries; (6) non-rigid registration multi-mode image fusion surgical navigation system; (7) image feature extraction and prediction model establishment. The workflow of this system includes: First, CT data acquisition and 3D visualization of hepatobiliary and pancreatic diseases; followed by individualized vascular assessment, liver volume calculation and surgical planning using the 3D model; then virtual simulation surgery, 3D printing, virtual reality technology and molecular fluorescence imaging accordance to the required specific conditions. Preoperative radiomics are used to predict the risk of complications and long-term follow-up results. Intraoperative multi-modal fusion image navigation and its consistency are evaluated with the findings in actual surgery and preoperative planning. This technology, hopefully, will bring in novel strategies and approaches in the diagnosis and treatment of hepatobiliary and pancreatic diseases.
ABSTRACT
In managing their patients,surgeons have to make clinical decisions.Looking back,some decisions are correct,while others are incorrect.Does making a wrong clinical decision by a surgeon constitute professional negligence? Typically,a surgical decision has to be made within a relatively short time,as the patient's condition often would not allow any delay in treatment.When a decision is made,it often has to be made when there are inadequate data,and the decision is often a major one:to operate or not to operate.In summary,any clinicalsurgical decision should be based on a clear knowledge of when and what decision has to be made,a full understanding of all the available options,the pros and cons of each option,a full understanding of the opinion and the wish of the patient and his/herrelatives and friends,a clear appreciation of the surgeon's own ability,adequate and clear communication with the patient and his/her relatives and friends on the reasoning behind the decision.
ABSTRACT
Laparoscopic pancreatic surgery represents one of the most advanced applications for laparoscopic surgery currently in use.In the past,minimally invasive techniques in pancreatic surgery were only used for diagnostic laparoscopy,staging of pancreatic cancer and palliative procedures for unresectable pancreatic cancer.A growing number of case series and multi-institutional reports on safety and efficacy of minimally invasive pancreatic resection have been published.Current knowledge on minimally invasive pancreatic resection is based mainly on short-term outcomes from a small number of centers with cohorts too small to make strong arguments for or against its use.In carefully selected patients,minimally invasive pancreatic resection is safe and feasible.However,the procedure should only be attempted by surgeons who are experienced in open pancreatic surgery and in laparoscopic surgery.The role and oncologic safety of minimally invasive approach for pancreatic resection for pancreatic cancer remain unknown.
ABSTRACT
This article traced how western medicine and surgery were introduced into China, described where Chinese surgery stands currently at the international scene, and proposed future strategies as to how Chinese surgery can go internationally. Surgery, a major component of western medicine,was first introduced into China in the late 19th and early 20th centuries through the missionaries and the merchants of the East Indian Company. Surgical centers were soon established in the big cities along the coastal region, then spread inland along the Yellow River, the Yangtze River and the Pearl River. The establishment of general surgery centers soon led to the development of the subspecialty in hepatopancreatobiliary surgery because of high prevalence of hepatitis B related hepatocellular carcinoma, intrahepatic stones, portal hypertension caused by schistosomiasis and pancreatic disease. For historical reasons,Chinese surgery was cut off from the outside world in the 1960s.This led to the development of Chinese surgery along a different path from that taken internationally. With the opening up of China in the 1980s, and the recent economic developments,Chinese surgery needs to merge with surgery in the rest of the world. Suggested proposal for future strategies for Chinese surgery to go internationally include undergraduate medical reform, introduction of structured surgical training and examination for the whole country, life long continuing medical education for all surgeons, academic exchanges with internationally renowned centers, publication in international peer-review journals, active involvement in international surgical societies and conferences.
ABSTRACT
This is a series of four papers on "Gallbladder Cancer" written by the most famous hepatobiliary surgeons and oncologists in China. The titles of the papers are: ( 1 )" Preoperative management of patients with suspected gallbladder cancer"by CHEN Wei and LIANG Li-jian; (2)"Selection of surgical procedures for gallbladder cancer" by PENG Shu-you and HONG De-fei; (3) "Diagnosis and treatment of incidental gallbladder cancer" by JIANG Xiao-qing and QIU Ying-he; (4)"Comprehensive management of gallbladder cancer" by WANG Jian-dong and QUAN Zhi-wei. These papers emphasize on the following important points on gallbladder cancer: (1)Laparoscopic cholecystectomy is absolutely contraindicated when gallbladder cancer is known or suspected pre-operatively; patients with a pre-operative suspicion of gallbladder cancer should undergo laparotomy, exploration and cholecystectomy after proper pre-operative assessment; (2)With the exception of Tis and T1a tumors, all patients with resectable gallbladder cancer should receive radical cholecystectomy, and a R0 resection should be aimed at; ( 3 ) For patients whose cancer is an incidental finding on pathological review, a second radial resection should be carried out as soon as possible, except for Tis and T1a diseases;(4) There is very little role for chemotherapy and radiotherapy in the adjuvant or palliative treatment of gallbladder cancer; (5)Surgery is the only curative treatment for gallbladder cancer.
ABSTRACT
Liver surgery is composed of hepatic anatomy and relevant surgical techniques.The research of hepatic anatomy promotes the development of surgical techniques,and then the science of liver surgery get evolved.The knowledge of the liver anmomy,hepatic functional reserve,capacity to regenerate,and prevention of hemorrhage is essential for a successful hepatectomy.Hepatectomy has advanced remarkably in the past 30 years,but major challenges remain,which include developing more efficient minimally invasive surgical techniques,improving patient selection for any given treatment modality,and eliminating the chance of tumor recurrence,particularly in the liver.
ABSTRACT
Minimally invasive therapy is gaining increasing attention as an important part of therapies in hepatocellular carcinoma (HCC). It includes laparoseopic liver resection, transarterial therapy, local ablative therapy and some new extraeorporeal energy therapies. The theoretical advantages of laparoscopic liver resection are those of minimally invasive surgery in general, such as early recovery, shorter hospital stay, and better cosmetic outcome. However, laparoseopie liver resection for HCC is still considered as controversial because of the uncertainty of the long-term results, and fear of compromising the principles of oncologic resection. Transarterial chemoembolization is the most promising palliative medality for uuresectable HCC, but other techniques, such as transarterial radioembolization and local ablative therapy, have also shown promising results. Recent evidence suggests that local ablative therapy may offer comparable survival outcomes in patients with small HCC and preserved liver function when compared with partial hepatectomy. This article focuses on the development in minimally invasire therapy of HCC.