With the progress in muhimodality therapy, the management of hepatocellular carcinoma (HCC) comes to an era of diversification. Dudng the last 2 decades, the increased understanding of biological behaviors of HCC and innovations of various treatment modalities has led to dramatic changes in concepts and strategies of treatment for HCC. The changes include the shifts from experience-based medicine to evidence-based medicine, from rough treatment to precise treatment and from single therapy to integrated therapy. The implementation of these concepts and therapies will further improve the chance of survival and the quality of life for HCC patients.

The concept of minimally invasive surgery is adopted in the diagnosis and treatment of biliary diseases,while during the process,the biological function of the sphincter of Oddi is ignored,and blind expansion of indications of endoscopic sphincterotomy (EST) severely affected the function of the sphincter of Oddi.In this condition,protection of the sphincter of Oddi should be attached great importance.Proper selection of diagnosis method,strictly control of the indications of EST,timely repair the injured sphincter of Oddi are important for a better prognosis of patients with biliary diseases with preservation of the function of the sphincter of Oddi.

The principles of “precise liver surgery”include to absolutely clearing target lesions,ensuring structural　integrity of residual liver,maximizing the volume of remnant　liver,controlling bleed as well as minimizing hepatic parenchymal damage and surgical invasiveness.This theory serves the　whole procedure of liver surgery for the optimal recovery of　patients.The major strategies consist of accurate preoperative　evaluation:rigorous surgical planning,refined surgical operation　and meticulous perioperative care.The construction of “recise　liver surgery” system requires the combination of modern technology and traditional surgery,and the breakthrough in the core　theory and key techniques of liver surgery.

With inheritance of scientific spirit of Huang Zhiqiang,depending on the modern science and technology of evidence-based medicine methods,digital surgical technique,molecular imaging technique,minimally invasive technology,genomics and proteomics technology and Big Data analytics,giving full play to the characteristics of precision surgery,which include evidence-base,quantification,visualization and controllability,a new era of biliary surgery in China is inaugurated.

Continnous theoretical and technological progress in the face of increasing expectations for quality of health care and progress in medical technology has transformed the surgical paradigm.Based on the historical trends and technique advances,a novel paradigm ofPrecision Surgery has been proposed,which is featuring certainty-based practice to ensure the best results for each patient with multi-objective optimization of therapeutic effectiveness,surgical safety and minimal invasiveness.The main characteristics of precision surgery may be summarized as determinacy,predictability,controllability,integration,standardization and individualization.The strategy of precision hepatic surgery is to seek a balance of maximizing the removal of the target lesions,while maximizing the functional remnant liver and minimizing surgical invasiveness.The concept of precision surgery should be considered for wider application in liver surgery and other fields as a step toward the ultimate goal of perfect surgery.

Esophageal variceal hemorrhage is a severe complication of portal hypertension.Non selective-blockers and endoscopic variceal ligation have been utilized to prevent variceal hemorrhage as the first line therapeutic measures.The role of surgical approaches in the treatment of portal hypertension is still controversy.The selective shunt operation,devascularization operation,transjugular intrahepatic portosystemic shunt and liver transplantation have their own indications and limitations.Based on the precision surgical therapy,individualized selection of suitable surgical management on portal hypertension should be advocated to minimize invasiveness and cost-effect ration,maximize organ saving and outcome.For patients with extrahepatic portal hypertension,Meso-Rex bypass operation could be the preventive treatment method,surgical treatment could be applied to patients with regional portal hypertension.

Continuous progress of medicine and related areas are initiating and motivating a paradigm transformation of traditional surgery to precise surgery,which is characterized by precision in decision making and surgical intervention.The strategy of precise surgery is to seek a balance of maximized lesion removal,maximized organ sparing and minimal surgical invasiveness.Due to the special location and biological characteristics,the therapy of hilar cholangiocarcinoma is still challenging.To meet the demand of precise surgery,the knowledge of anatomy,biological characteristics and liver functional reserve is needed and the technical aspects of pre-surgical intervention,liver resection and reconstruction of vessels are also very important.

Objective To observe whether coagulation zones can be produced by intraductal radiofrequency ablation (RFA) in vivo and investigate the effect of portal blood flow on the sizes of coagulation zones. Methods Fourteen bile duct targets in hepatic hilar from 6 swines were equally divided into non-Pringle manoeuvre group and Pringle manoeuvre group. A 13mm segment of non-insulated mono-electrode was inserted into the bile duct, then RFA was performed under the condition of 5 W power output for 4 minutes. The pathological changes of bile duct and adjacent hepatic tissues were observed. Results Semi-oval offwhite coagulation zones in the sections were observed in both groups, with obvious dark-red rims around them. Necrosis and denaturation of mucosal and submucosal layers of bile duct and denaturation of adjacent hepatic tissue in coagulation zones were observed under optical microscope. The dark-red rims revealed hepatic hemorrhage. The mean long axial diameter of coagulation zones in the non-Pringle manoeuvre group and Pringle manoeuvre group was (13.29±1.38)mm and (13.29±1.1 1)mm, respectively, with no statistical difference (t=0.000, P>0.05). The mean short axial diameter of coagulation zones in the non-Pringle manoeuvre group and Pringle manoeuvre group was (3.14±1.07)mm and (4.57±0.98)mm, respectively, with statistical difference (t=2.611, P<0.05). Conclusions Intraductal RFA can produce a typical ablation zone. The portal blood flow affects the short axial diameter of coagulation zone but does not affect the long axial diameter.

The sphincter of Oddi is a valve that controls the biliopancreatic duct and plays an irreplaceable role in maintaining normal physiological functions of the biliopancreatic duct.However,sphincteroplasty and sphincterotomy may cause varying degrees of damage to the function of the sphincter of Oddi,which may further result in postoperative reflux of duodenal fluids and bacterial contamination in bile and increase the risks of recurrent common bile duct stones,reflux cholangitis,and even cholangiocarcinoma.Therefore,clinical physicians should protect the structure and function of the sphincter of Oddi.Based on our experience,under the premise that the extrahepatic bile duct can be preserved,patients with iatrogenic injury of the sphincter of Oddi can be treated with transduodenal sphincteroplasty to restore the structural integrity of the sphincter of Oddi and reduce biliopancreatic duct complications secondary to loss of function.

Hepatic veins as the only hepatic drainage veins are the important functional part of liver anatomy in the field of surgery.With the development of imaging technology,especially the application of three-dimensional visualization technology,it can provide precise and comprehensive information in the study of hepatic veins.And thus this paper comprehensively reviewed the recent researches on the three dimensional visualization technology for observign the hepatic veins.