After more than thirty years of development, laparoscopic surgery technology has become the main platform for surgery and has been widely applied in various fields of surgery. The safety, feasibility and efficacy of laparoscopic technique have already been confirmed in colorectal surgery. In recent years, with a deeper understanding of concepts such as laparoscopic fascial anatomy, laparoscopic colorectal surgery has made new explorations and advances in surgical approach selection, NOSES, lymph node dissection range, preservation of Denonvillier's fascia, functional protection, lateral lymph node dissection, selection of anal preservation techniques for ultra-low rectal cancer, and totally laparoscopic digestive tract reconstruction. In the field of laparoscopic gastric surgery, evidence-based medical evidence in China has entered a harvest period, moreover, functional preservation surgery, esophageal gastric junction adenocarcinoma, and total laparoscopic anastomosis have also become hot topics in this field with new progress. The medical equipment related to minimally invasive surgery has also been developping in recent years and has played an important role in improving minimally invasive surgery.

Laparoscopic colorectal surgery has been carried out in China for more than 30 years and has experienced a three-stage high-speed development of "exploring and designing,optimising and standardising, perfecting and re-innovating" at the technical level. Based on the support and assistance of laparoscopic technology, colorectal surgery has made rapid progress in sub-microscopic anatomy, surgical procedures, surgical concepts, instruments and equipment. Nowadays, the technology and efficacy of laparoscopic colorectal surgery have gradually reached the ceiling, and in view of the existing pain points and the future direction of development, where will we go? This article summarised the past three decades of experience and consolidate the results to guide the future practice and the way forward.

Objective To investigate the application of synchronized immersion course(SIC)in teaching of clinical practice of surgery for eight-year program students.Methods A total of 94 eight-year program students in French class and 4+4 class who received SIC in the study of surgery in Ruijin Clinical School,Shanghai Jiao Tong University from September 2017 to June 2019 were selected as the pilot group.A total of 91 students in English class who were taught in the traditional way in the same period were selected as a horizontal control group.A total of 84 students in French class and 4+4 class who were studying from September 2015 to June 2017 were selected as the longitudinal control group.Teaching satisfaction evaluation,examination results and specialization choice were compared among students in each group to assess teaching effectiveness.Results The total score(3.8±0.3)and satisfaction rate(98.9%)of the questionnaire in the pilot group were better than those in the horizontal control group(3.6±0.4,90.1%)(P=0.001,P=0.008).For the case analysis station in objective structured clinical examination(OSCE),the mean score(86.2±6.9)and pass rate(97.9%)in the pilot group were better than those in the horizontal control group(79.7±11.4,89.0%)(P=0.001,P=0.014),as well as better than those in the longitudinal control group(79.5±13.5,88.1%)(P=0.001,P=0.009).For the history inquiry station,the mean score(86.3±10.7)and pass rate(96.8%)in the pilot group were better than those in the horizontal control group(81.4±11.6,86.8%)(P=0.003,P=0.013).The proportion of students choosing the surgical specialty was higher in the pilot group(55.3%)than in the horizontal control group(46.2%)and the longitudinal control group(44.0%)without statistically significant difference.Conclusions SIC can help eight-year program students strengthen their clinical thinking and practice skills.Meanwhile,SIC can increase students'satisfaction with teaching and their interest in surgery.

Laparoscopic colorectal surgery has been carried out in China for more than 30 years and has experienced a three-stage high-speed development of "exploring and designing,optimising and standardising, perfecting and re-innovating" at the technical level. Based on the support and assistance of laparoscopic technology, colorectal surgery has made rapid progress in sub-microscopic anatomy, surgical procedures, surgical concepts, instruments and equipment. Nowadays, the technology and efficacy of laparoscopic colorectal surgery have gradually reached the ceiling, and in view of the existing pain points and the future direction of development, where will we go? This article summarised the past three decades of experience and consolidate the results to guide the future practice and the way forward.

After nearly 40 years of development, minimally invasive techniques have been widely applied in curative surgeries for various types of tumors. The safety and efficacy of minimally invasive surgery has being fully validated. With the continuous iteration and updating of medical equipments, the convenience and precision of surgeries have been significantly enhanced, marking the advancement of minimally invasive surgery into a phase of high-level platform. With the rapid development of information technology, we have gradually entered the era of intelligent medicine, where the integration of technologies such as artificial intelligence will inject new vitality into the development of minimally invasive surgery. Combined with the latest research trends, the authors provide an in-depth analysis of how artificial intelligence plays a unique role in key aspects of minimally invasive surgery, including preoperative assessment and planning, intraoperative moni-toring and alerting, and comprehensive postoperative management. Additionally, the authors discuss how to utilize these innovative technologies to further promote reforms in medical education and prospects for the development of telemedicine service. In the era of intelligent medicine, the develop-ment of minimally invasive surgery should adhere to the principle of "bold innovation, cautious practice", guided by the concept of "patient-centeredness". By promoting interdisciplinary collabora-tion between medicine and engineering, accelerating the translation of scientific and technological achievements into clinical practice, we can ensure that minimally invasive surgical techniques better serve the health and well-being of the people.

Objective To explore drug use patterns in treatment of lung cancer based on traditional Chinese medicine inheritance assistance platform.Methods A total of 200 effective prescriptions for the treatment of lung cancer patients in the outpatient department of Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from January 2022 to September 2023 were collected and input into the traditional Chinese medicine inheritance assistance platform to conduct association rules and cluster analysis of drugs.Results A total of 200 effective prescriptions were included,involving 146 traditional Chinese medicines.The medicinal properties were mainly cold,warm and flat,and the medicinal flavours were mainly sweet,bitter and pungent,which mainly belong to lung,spleen,stomach and heart meridian.The most frequently used Chinese medicines were Radix Codonopsis Lanceolatae,Radix et Rhizoma Glycyrrhizae,Radix et Rhizoma Salviae Miltiorrhizae,Rhizoma Pinelliae,Actinidia valvata Dunn,Fritillariae Thunbergii Bulbus,etc.27 groups of core drug combinations were obtained,and 5 new prescriptions were obtained.Conclusion Clinical diagnosis and treatment of lung cancer is closely related to the core pathogenesis of Yin deficiency and stasis toxicity,and at the same time,it takes care of the acquired spleen and stomach,mind-body harmony,reflecting the academic thought of traditional Chinese medicine tumor,which reinforce healthy qi to anti-cancer and the holistic view of traditional Chinese medicine.

Objective:To investigate the clinical value of magnetic resonance imaging (MRI) based integrated deep learning model for predicting the times of linear staplers used in double stapling technique for middle-low rectal cancer resection.Methods:The retrospective cohort study was conducted. The clinicopathological data of 263 patients who underwent low anterior resection (LAR) for middle-low rectal cancer in Ruijin Hospital of Shanghai Jiaotong University School of Medicine from January 2018 to December 2022 were collected as training dataset. There were 183 males and 80 females, aged 63(55,68)years. The clinicopathological data of 128 patients with middle-low rectal cancer were collected as validation dataset, including 83 males and 45 females, with age as 65(57,70)years. The training dataset was used to construct the prediction model, and the validation dataset was used to validate the prediction model. Observation indicators: (1) clinicopathological features of patients in the training dataset; (2) influencing factors for ≥3 times using of linear staplers in the operation; (3) prediction model construction; (4) efficiency evaluation of prediction model; (5) validation of prediction model. Measurement data with skewed distribution were represented as M( Q1, Q3), and Mann-Whitney U test was used for comparison between groups. Count data were expressed as absolute numbers, and comparison between groups was conducted using the chi-square test. Wilcoxon rank sum test was used for non-parametric data analysis. Univariate analysis was conducted using the Logistic regression model, and multivariate analysis was conducted using the Logistic stepwise regression model. The receiver operating characteristic (ROC) curve was draw and the area under the curve (AUC) was calculated. The AUC of the ROC curve >0.75 indicated the prediction model as acceptable. Comparison of AUC was conducted using the Delong test. Results:(1) Clinicopathological features of patients in the training dataset. Of the 263 patients, there were 48 cases with linear staplers used in the operation ≥3 times and 215 cases with linear staplers used in the operation ≤2 times. Cases with preoperative serum carcinoembryonic antigen (CEA) >5 μg/L, cases with anastomotic leakage, cases with tumor diameter ≥5 cm were 20, 12, 13 in the 48 cases with linear staplers used ≥3 times in the operation, versus 56, 26, 21 in the 215 cases with linear staplers used ≤2 times in the operation, showing significant differences in the above indicators between them ( χ2=4.66, 5.29, 10.45, P<0.05). (2) Influencing factors for ≥3 times using of linear staplers in the operation. Results of multivariate analysis showed that preoperative serum CEA >5 μg/L and tumor diameter ≥5 cm were independent risk factors for ≥3 times using of linear staplers in the operation ( odds ratio=2.26, 3.39, 95% confidence interval as 1.15-4.43, 1.50-7.65, P<0.05). (3) Prediction model construction. According to the results of multivariate analysis, the clinical prediction model was established as Logit(P)=-2.018+0.814×preoperative serum CEA (>5 μg/L as 1, ≤5 μg/L as 0)+ 1.222×tumor diameter (≥5 cm as 1, <5 cm as 0). The image data segmented by the Mask region convolutional neural network (MASK R-CNN) was input into the three-dimensional convolutional neural network (C3D), and the image prediction model was constructed by training. The image data segmented by the MASK R-CNN and the clinical independent risk factors were input into the C3D, and the integrated prediction model was constructed by training. (4) Efficiency evaluation of prediction model. The sensitivity, specificity and accuracy of the clinical prediction model was 70.0%, 81.0% and 79.4%, respectively, with the Yoden index as 0.51. The sensitivity, specificity and accuracy of the image prediction model was 50.0%, 98.3% and 91.2%, respectively, with the Yoden index as 0.48. The sensitivity, specificity and accuracy of the integrated prediction model was 70.0%, 98.3% and 94.1%, respectively, with the Yoden index as 0.68. The AUC of clinical prediction model, image prediction model and integrated prediction model was 0.72(95% confidence interval as 0.61-0.83), 0.81(95% confidence interval as 0.71-0.91) and 0.88(95% confidence interval as 0.81-0.95), respectively. There were significant differences in the efficacy between the integrated prediction model and the image prediction model or the clinical prediction model ( Z=2.98, 2.48, P<0.05). (5) Validation of prediction model. The three prediction models were externally validated by validation dataset. The sensitivity, specificity and accuracy of the clinical prediction model was 62.5%, 66.1% and 65.6%, respectively, with the Yoden index as 0.29. The sensitivity, specificity and accuracy of the image prediction model was 58.8%, 95.5% and 92.1%, respectively, with the Yoden index as 0.64. The sensitivity, specificity and accuracy of the integrated prediction model was 68.8%, 97.3% and 93.8%, respectively, with the Yoden index as 0.66. The AUC of clinical prediction model, image prediction model and integrated prediction model was 0.65(95% confidence interval as 0.55-0.75), 0.75(95% confidence interval as 0.66-0.84) and 0.84(95% confidence interval as 0.74-0.93), respec-tively. There was significant differences in the efficacy between the clinical prediction model and the integrated prediction model ( Z=3.24, P<0.05). Conclusion:The MRI-based deep-learning model can help predicting the high-risk population with ≥3 times using of linear staplers in resection of middle-low rectal cancer with double stapling technique.

Represented by colorectal cancer, gastrointestinal malignancies have unique clinical characteristics and biological behaviors, ranking high in the incidence and mortality rates in China. In recent years, with technological innovations and continuous optimization of disease management models, the concept of "precision surgery" has been driving the transformation of colorectal cancer surgery from traditional empirical surgical paradigms to modern precision surgical paradigms. Rapid advancements have been made in colorectal surgical treatment, including surgical techniques, instrument platforms, various novel targeted therapies, and immune combination therapies, which have demonstrated significant efficacy in colorectal cancer treatment. Meanwhile, with 30 years of development in laparoscopic colorectal surgery in China, the surgical approach for colorectal cancer has shifted from traditional open-bellied surgery to minimally invasive surgery. The diagnostic and therapeutic models for colorectal cancer patients have gradually transitioned from experience-driven to precision-based and individualized care. Guided by the concept of "precision surgery", this article combines the current status and trends in colorectal cancer surgery to discuss relevant molecular subtyping and precision treatment strategies, aiming to promote precise surgery and comprehensive treatment for colorectal cancer.

Virtual reality (VR) is a technology that interacts computer-generated three-dimensional scenes with the user′s senses and has been gradually applied in the real medical field. Since the first time of successful attempt in 3D laparoscopic gastrointestinal surgery VR living video broadcast in 2016, the authors have experienced the exploration of the application of this technology (2016-2017) as well as the in-depth research phase (2018-2019). Nowadays, the VR application in our center has entered into the application practice phase (2020 to present). With the technology iteration and more and more application experience acquisition, our current VR application mainly focuses on two practice settings, including the clinical teaching scenarios for early exposure to acute appendicitis for medical undergraduate students and the preoperative communication to give pati-ents an early sense of the process in the operating theatre, and has achieved good application results. With continuous breakthroughs and innovations in software and hardware, we believe that more clinical VR scenarios and the course audience will be expanded to a wider group. The integration of some new hotspots such as Meta-Universe and ChatGPT will make up for the shortcomings in VR content scenarios and interactivity, and its application prospects are infinite.

The application of minimally invasive surgery has experienced rapid develop-ment for more than 30 years. The continuous development of minimally invasive technology and instru-ments in the fields of energy platform and imaging equipment has promoted the progress of laparos-copic surgery to be more accurate and secure, and the development of laparoscopic surgery itself has also continuously fed back the innovation of technology and instruments. In recent years, the innovative development of minimally invasive technology and instruments has been more closely combined with the current scientific and technological frontier, leading to the innovative achievements in the fields of robotic surgery, screenless surgery, artificial intelligence, electronic instrument, virtualization and so on. In the new era, surgeons should always keep an eye on the forefront of science and technology, the combination of surgery and technology, application of advanced technology to solve the key problems of current surgery, so as to inject new vitality into the next development of minimally invasive surgery.