During the growing and progressing process of clinical training for digestive surgeons, either as trainee or trainer, definite direction or goal would be set up in advance, followed by corresponding plans including short-term and longterm.The overall skeleton structure should be highly suitable and specific in order to have a lucid exposition of an outline and significant benefits.Usually the following should not be forgotten forever otherwise would be condemned unfortunately: continuous education and study to keep up with new knowledge and technology;multidisciplinary working together and cooperative aspiration;past experience to learn and sum up for yourself and other body;correct clinical and dialectic point thinking which lead to the goal to be made up ever and twice the result with the half effort.

There are two-way factors which will play important roles in the growth and development of surgeons in digestive surgery,namely their own efforts and guidance and training from chief surgeons.The eternal core of the process could be summarized as 3N:never ignore responsibility; never too old and too much to learn; never forget the past,otherwise,would be condemned.

Iatrogenic bile duct injury (IBDI) is a severe complication in general surgery, especially during laparos-eopic cholecystectomy. Many factors may cause IBDi, in which the conscientiousness, skill and experience of the surgeons play a more important role than the abnormal anatomy and patholo-gical changes of the patient. The Bismuth's classification, which originated from the era of open surgery, does not cover the whole spectrum of bile duct injuries. Strasberg's classification made a supplement by including other types of extrahepatie bile duct injuries. The variation of opportunities leads to different thera-peutic strategies. When the injuries are diagnosed intraopera-tively, a conversion to open surgery is the option of choice, and the prosthesis should be performed by a more experienced surgeon. If the bile duct injury is diagnosed in the early stage after operation, therapeutic principles are as follows: biliary peritonitis often required an emergency reoperation, while extra-peritoneal drainage is taken for patients with simple biliary leak. The most serious postoperative complication after IBDI is steno-sis, sometimes followed by fistula. Sufficient preoperative prepa-ration is essential, which includes controlling the biliary tract infection, improving the liver and renal function and nutritional state of the patient.

Liver is the largest parenchymal organ in human body and the most commonly injured organ in abdomen,accounting for 20％ of all abdominal traumas.Traumatic liver rupture can bring about intra-abdominal hemorrhage,peritoneal irritation and hemorrhagic shock.If the liver trauma takes place in peri-hepatic veins or multiple-organ injury,mortality rate is increased.In recent years,with more studies on liver injury and the rapid development of modern surgical techniques as well as the equipments,the strategies and means of liver trauma treatment have greatly changed.These changes include liver trauma cases with nonoperative treatment have been increased gradually,the improvement of damage control packing,the application of fast-track surgery concept in liver trauma,etc.

Hepatocellular carcinoma (HCC) in nonimpaired livers are a type of HCCs arising in non-cirrhotic,non-fibrotic livers without viral hepatitis or alcohol abuse.Liver resection is the major form of treatment.Factors considered when developing a prognostis include R0 liver resection,hepatocellular function,recurrence,vascular invasion,transfusion,tumor size,tumor number,tumor capsule,and daughter nodules.So the prognosis can be predicted through the analysis of these factors during preoperative and perioperative period. The curative effects of the operation can be enhanced by optimizing treatment based on the analysis of these prognostic factors.

The spleen whose size reaches or exceeds third degree should be regarded as massive splenomegaly.Splenectomy for massive splenomegaly demands precise procedures.First,median incision on upper abdomen(or vertical rectus muscle splitting incision)and incision under left costal arch are preferred.Second,the spleen was freed and then 0.33 mg of epinephrine was injected via the splenic artery before splenic artery ligation.During the process,a cell saver helps to minimize blood loss and makes autoinfusion possible for patients with benign lesions.Third,preoperative administration of fibrinogen,platelet and essential styptieum combined with the cooperation between surgeons and anesthesi010gists are the key points of bloodless surgery which is important for the recovery of patients.Four common problems of splenectomy for massive splenomegaly should also be addressed,including operation discontinuance,perioperative hemorrhage,accessory injury and postoperative intractable fever.

Precise hepatectomy is the application of minimally invasive concept in hepatic surgery. There are big challenges for surgeons to choose the proper approaches to achieve the aim of precise hepatectomy. How to choose therapeutic strategy, chemotherapy, radiotherapy, liver transplantation or radiofrequency ablation? How to choose the operation type, laparoscopic surgery, transabdominal surgery or Da Vinci robot-assisted surgery? How to choose the surgical instruments during hepatectomy? Although answers for these questions are various, the principle is unchangeable, which is providing minimal injury, less blood loss, fast recovery, little expense and good prognosis. The concept of precise hepatectomy includes precise judgment of liver function and careful preparation before operation, and also the elaborate nursing and multi-disciplinary cooperation during operation, as well as the fast track surgery after operation. Precise hepatectomy requires surgeons take the safety and effectiveness of the operations into account, and the conditions of hospitals, the skills and experiences of the surgeons should also be evaluated before operation. Finally, the economic condition of the patients should be considered and proper application of advanced equipments should be emphasized.

The splenic surgery has a long history of 400 years and the basic principle of selective splenectomy is finally defined.With the enhancement of the notion of preserving spleen and the modifications and improvements of the technology,the splenic surgery has made great progress both in spleen-preserving surgery and splenectomy.For the sake of preserving spleen,innocent splenectomy is avoided as much as possible.Moreover,splenic function is preserved to the largest extent through the substitution of partial splenectomy for total splenectomy or the precise resection of the lesion.On the other hand,in some circumstances,the spleen cannot be preserved.The splenectomy with a series of improvements is very safe in spite of massive splenomegaly.With the development of the technology,the splenic surgery also keeps up with times and continuously innovates.The laparoscopic technology and robotassisted technology bring new energy to the splenic surgery,clinical values of which are being explored and expanded,with a wide development space.

The anatomy and position of choledocho-pancreatico-duodenal junction are unique,so choledocho-pancreatico-duodenal junction is easily be injured during operation,and thus it needs further investigation.Anatomical,pathological and iatrogenic factors are the 3 main causes of choledocho-pancreatico-duodenal junction injury.The diagnosis of choledocho-pancreatico-duodenal junction injury includes intraoperative and postoperative diagnosis; and the treatment methods include intraoperative repaire and suture,T tube drainage,postoperative debridement and drainage,biliopancreatic shunt,duodenal diverticulum,jejunum stoma,gastrointestinal and biliary reconstruction.Precise operation,T tube cholangiography,choledochoscopy can effectively prevent the choledocho-pancreatico-duodenal junction injury.The principle of early discovery,early management,avoiding over-management,and promoting damage control surgery should be awared to reduce the mortality.

Laparoscopic splenectomy (LS) is considered as the standard approach for patients with normal-sized or moderately enlarged spleens because of advantages of minimal invasion.With the improvement of laparoscopic techniques,the previous concept that massive splenomegaly (MS) is a contraindication to LS is being challenged.Nevertheless,there is still a tremendous controversy over this issue.(1) Splenomegaly and MS are not clearly defined.(2) The feasibility,safety and postoperative outcomes of LS for MS are fiercely debated despite much improvement of LS for MS.(3) Whether supporting or opposing LS for MS,the core problem that the upper limit of splenic size can be in accord with a requirement of LS is controversial.Taking these issues into account,authors recommended that the splenomegaly shotdd be divided into four degrees rather than three degrees for the sake of guiding the choice of surgery.