1.Chinese guidelines for minimally invasive surgical technique in living donor liver transplan-tation (2024 edition)
Chinese Journal of Digestive Surgery 2024;23(4):479-491
Minimally invasive surgery plays a crucial role in modern medicine. With advan-tages such as less trauma, precise operation, intraoperative minimal bleeding, and rapid postopera-tive recovery, minimally invasive procedures have been increasingly applied in the field of liver transplantation in recent years. This include techniques such as small incision living donor hepatec-tomy through an upper abdominal midline incision, laparoscopic-assisted living donor hepatectomy, pure laparoscopic living donor hepatectomy, and robotic living donor hepatectomy. Since professor Cherqui from France firstly reported the total laparoscopic left lateral sectionectomy in living donors in 2002, the application of minimally invasive technology in living donor liver transplantation has become increasingly widespread. Based on this, so as to guide the more standardized, effective, and safe implementation of minimally invasive liver donor hepatectomy across the country, in August 2023, Branch of Organ Transplant of China Medical Association, combined with Branch of Organ Transplant Physicians of Chinese Medical Doctor Association organize national liver transplan-tation experts to jointly formulate the Chinese Guidelines for Minimally Invasive Surgical Techniques in Living Donor Liver Transplantation ( 2024 Edition). This is to provide scientific guidance and reference for surgeons performing minimally invasive surgery on living liver donors in China.
2.Chinese expert consensus on conversion and perioperative therapy of primary liver cancer (2024 edition)
Chinese Journal of Digestive Surgery 2024;23(4):492-513
In China, over half of liver cancer patients are in advanced stage at initial diagno-sis, losing the opportunity for curative surgical resection, and part of resectable patients have a high postoperative recurrence rate, resulting in poor overall survival. Innovations in surgical techniques and advancements in systemic and locoregional treatments have paved the way for novel and multi-combination conversion treatment strategies. These approaches offer selected advanced liver cancer patients the prospect of tumor shrinkage and downstaging, ultimately facilitating surgical interven-tion, so as to achieve long-term survival benefits. Furthermore, further exploration has been taken in timing of surgery, assessment of lesions, prediction of efficacy, management of complications in the context of conversion and perioperative therapy. Based on previous edition of guideline, the updated Chinese Expert Consensus on Conversion and Perioperative Therapy of Primary Liver Cancer ( 2024 Edition) aims to collect and summarize current clinical experience of conversion therapy and peri-operative therapy, propose remaining problems that need to be solved in conversion therapy and peri-operative therapy and provide a foundation for further research and development of liver cancer treatment in clinical practice.
3.Chinese expert consensus on precision guidance technology in diagnosis and treatment of liver tumors(2024 edition)
Chinese Journal of Digestive Surgery 2024;23(4):514-526
Most patients with liver malignant tumors are diagnosed as in the middle or advanced stages when first diagnosed, while the prognosis is quite poor in these stages. Early diagnosis and treatment are the key to improve the curative effect of liver malignant tumors. Recently, with the sustainable development and progress of the treatment method, the prognosis of liver malignant tumors has been greatly improved. The surgical resection is still the first-choice in the treatment of liver malignant tumors. Precise hepatectomy is the guarantee to achieve the best surgical results, while precise preoperative assessment, intraoperative real-time lesion localization and real-time guidance are the priority to the precise hepatectomy. In order to improve the pre-operative diagnosis, precise intraoperative resection and postoperative curative effect of liver malignant tumors, the Hepatobiliary and Pancreatic Disease Prevention and Control Specialty Society of Chinees Prevention Medicine Association and the Hepato-Oncology Branch of China International Exchange and Promotive Association for Medical and Healthcare organize experts to conduct in-depth discussion on the key points of precise localization and navigation of liver tumors and formulated the Chinese Expert Consensus on Precision Guidance Technology in Diagnosis and Treatment of Liver Tumors (2024 Edition), which could guide the clinical practice and promote the development of the subject.
4.Chinese expert consensus on comprehensive management of interventional therapy for liver cancer via radial artery approach (2024 edition)
Chinese Journal of Digestive Surgery 2024;23(4):527-535
Objective:To develop the Chinese expert consensus on comprehensive mana-gement of interventional treatment for liver cancer via radial artery approach (2024 edition), aiming to provide references for medical staff to develop standardized management path plans for liver cancer interventional treatment.Methods:Systematically search, evaluate, and summarize evidence related to liver cancer intervention therapy to form a consensus draft. There were 48 experts from 28 domestic hospitals in related fields invited to form an editorial and review committee, conducting 2 rounds of Delphi expert inquiries and 1 round of online expert discussion meetings, discussing and revising the initial consensus draft, and ultimately forming the final draft.Results:The consensus reached a consensus on 10 aspects: preoperative evaluation and preparation, health education, postoperative handover and monitoring, catheter and medication management, puncture site management, position and activity management, nutritional monitoring and dietary management, pain management and psychological support, and observation and management of complications.Conclusions:The con-sensus has formed a recommendation for comprehensive management of interventional treatment for liver cancer via radial artery approach, and a comprehensive perioperative management model has been established for reference by domestic peers.
5.Navigation and quantitative evaluation strategies for tumor fluorescent surgery based on arti-ficial intelligence and medical big data
Jie TIAN ; Kun WANG ; Di DONG ; Zhenyu LIU ; Zeyu ZHANG ; Mengjie FANG
Chinese Journal of Digestive Surgery 2024;23(4):536-542
The development of molecular imaging has been going on for more than 20 years. During this period, a large number of new imaging technologies for molecular imaging have been proposed, but only a small number of them have successfully achieved clinical transformation, entered the actual clinical application and achieved significant clinical results. Among them, intraoperative navigation based on fluorescence molecular imaging and quantitative analysis technology based on medical imaging big data are being carried out in more and more clinical trials and have gradually won wide recognition. Through the in-depth integration of these two technologies with artificial intelligence, a series of research results have been achieved in multiple clinical diagnosis and treat-ment processes such as preoperative diagnosis, intraoperative navigation and postoperative prediction of digestive system tumors, providing new technical support in the field of medical imaging for the individualized diagnosis and treatment of patients with digestive system diseases.
6.Advancements and prospects of minimally invasive surgery in the era of intelligent medicine
Minhua ZHENG ; Junjun MA ; Kefan DAI ; Shuchun LI
Chinese Journal of Digestive Surgery 2024;23(4):543-547
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.
7.Minimally invasive treatment strategies for hepatocellular carcinoma
Chinese Journal of Digestive Surgery 2024;23(4):548-553
China is a large country of hepatocellular carcinoma. Radical surgical resection remains a crucial means for long-term survival of patients with hepatocellular carcinoma. With advancements in technology and ideology, the indications for minimally invasive treatments such as laparoscopic and robotic liver resection, as well as local ablation therapy, continue to expand. Based on domestic and foreign literatures and personal experiences, the authors explore the minimally invasive treatment strategies for hepatocellular carcinoma: each minimally invasive treatment method possesses distinctive features and there is no absolute distinction between superiority and inferiority. It necessitates comprehensive consideration, scientific assessment, and personalized selection in practice to maximize patient benefits.
8.Current status and prospects of 5G network based remote medical robotic surgery
Chinese Journal of Digestive Surgery 2024;23(4):554-560
The combination of mobile communication technology and the medical field has given rise to telemedicine, whose clinical practice can greatly alleviate the problem of uneven distri-bution of regional medical resources and provide patients with instant and high-quality diagnostic and treatment services. The concept of telemedicine has also been applied in the field of surgery. With the rapid development of high-speed communication technology and robotic surgery systems, remote robotic surgery is gradually entering people′s vision. However, remote robotic surgery requires extremely high speed and stability in long-distance information exchange, and traditional communi-cation technologies are gradually unable to meet the development needs of remote robotic surgery. The fifth generation mobile communication technology, namely 5G network, is bringing significant changes to the development of remote healthcare, especially remote robotic surgery, due to its advantages such as high speed, high bandwidth, and low latency. The author has consulted relevant literature and combined with the team′s experience in conducting 5G remote robotic surgery, provi-ding a detailed introduction to the current application status and future prospects of 5G network based remote medical robotic surgery, aiming to promote the deep development and further promo-tion of this new technology.
9.Practical experience of simulative virtual system in the laparoscopic training among surgeons
Jiankun HU ; Kai LIU ; Boqiang PENG
Chinese Journal of Digestive Surgery 2024;23(4):561-565
With the rapid and widespread popularity of minimally invasive surgery, lapa-roscopic technology has become an indispensable core skill for contemporary surgeons. Based on the innovation of artificial intelligence and medical engineering integration technology, simulative virtual surgical medicine has also been rapidly developed and applied, providing a novel and effective tool for laparoscopic training. The authors′ team has systematically integrated the laparoscopic simulative virtual technology and led in conducting the empirical research on the application of laparoscopic simulative virtual technology in the practical skills examination of specialist physicians. They also developed laparoscopic training theory and operational practice courses. Besides, they normalized the training and assessment of simulated virtual systems. Notably, they formulated Chinese laparoscopic training and assessment standards, and constructed a phased and progressive training system for laparoscopic surgeons. The authors review relevant literature and discuss the exploration and practice of laparoscopic simulation virtual system in surgical residents training, in order to promote the standardization, normalization and homogenization of laparoscopic training in China.
10.Application and prospects of robot-assisted pancreatic surgery
Chinese Journal of Digestive Surgery 2024;23(4):566-572
Pancreatic surgery is a high-risk and highly complex procedure, and there are a series of challenges and limitations associated with minimally invasive pancreatic surgery. With the development of robotic technology, robot-assisted pancreatic surgery has gradually become an effec-tive means, and has become an important approach in pancreatic surgeries. The authors summarize the technical characteristics, clinical applications, operation outcomes, and advantages and limita-tions of robot-assisted pancreatic surgery, aiming to explore the application of robot-assisted pan-creatic surgery in modern medicine and to provide an outlook on its future development.

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