Financial Media Reporter Qiu Jia
Both feet move back and forth on the 7 pedals, hold the two handles with both hands, and the viewing angle of the image on the display changes as the ring moves. The operator is fully engaged in this series of actions. This is not playing an online game. This is a robotic hepatobiliary and pancreatic surgery in the Department of Hepatobiliary and Pancreatic Surgery of the People's Liberation Army General Hospital of .
On May 31 this year, the team of Director Liu Rong of the Department of Hepatobiliary and Pancreatic Surgery of PLA General Hospital completed the 5000th robotic hepatobiliary and pancreatic surgery, becoming the first surgical center in the world to break through 5000 robotic hepatobiliary and pancreatic surgery. From 1,000 cases in 2017 to 5,000 cases today, the Department of Hepatobiliary and Pancreatic Surgery has set world records time and time again, creating miracles one after another in the field of robotic hepatobiliary and pancreatic surgery.
Professor Liu Rong
Director of the Department of Hepatobiliary and Pancreatic Surgery, General Hospital of the People’s Liberation Army, Director of the Institute of Hepatobiliary Surgery of the PLA, Executive Member of the World Society of Clinical Robotic Surgery, and Chinese Research Hospital Association Director of the Intelligent Medicine Professional Committee, Vice President of the Medical Robotic Physician Branch of the Chinese Medical Doctor Association, etc. Enjoy the special allowance of the State Council of .
A more sophisticated and easy-to-operate surgical tool
Robotic surgery is very different from traditional open surgery and laparoscopic surgery . The robot transforms the doctor's actions into decomposed digitization, and then returns to the operating table to restore the actions, which are executed by the robotic arm. "If laparoscopy is to let our eyes leave the patient's real surgical field, the robot is to let your hands and eyes leave the operating table." Liu Rong introduced the robot in this way.
A major feature of the robot is that the operation is more delicate. "Like a laparoscope,The robot's camera is also 3D, but it is more realistic, similar to what we can restore with the naked eye. On the other hand, the magnification of the surgical field of the robot is higher, which can magnify more than 10 times, while the laparoscope is usually 3 to 5 times. At the same time, the robot arm has greater freedom of movement, 7 degrees of freedom and 540 degree rotation, making it more dexterous and convenient. The benefits of using such a tool in the clinic are obvious. "
However, when any new tool or method enters the application process, it will inevitably be questioned and even opposed by all quarters. "The most frequently heard sentence is,'I spent so much money to do such an operation, obviously This can be done in such a way, why use a robot to do it? '" At this time, Liu Rong would often give them an example like this: Why do you drive a car when you have a bicycle? Cycling is environmentally friendly and exercises, but if you need to reach farther places? It takes more effort and more. Time. Robots are the same. On the one hand, robots can provide better assistance for some precision operations; on the other hand, they can save time, reduce physical requirements for doctors, and reduce injuries to doctors.
"This point" I have a deep understanding. Before doing laparoscopy for a long time, I needed to stand on one leg. My knee joint was broken, my right leg was hanging in the air, my right shoulder was tilted up, and my spine was crooked when I was sitting. . These are the injuries to the surgeon caused by the long-term laparoscopic operation. The robot is relatively less damaged. The most obvious thing is to sit on the console, and the knee joint is not stressed. In the past, I used to perform three major open operations in a day, and I must have sweated profusely. Now I do it with a robot, and I do three operations a day, so I don’t feel tired. It can be said that this is the convenience brought by tools.
Liu Rong believes that the robot, like a laparoscope, is a tool for performing surgery. The key is to grasp the advantages of this tool, find out the rules in the use process, and explore new simple and easy surgical methods, and apply them. Promotion, and ultimately benefit more patients.
Perseverance and pioneering innovation can get to the forefront of the world
In November 2011, a robot left hepatectomy opened the robot hepatobiliary and pancreas of the Department of Hepatobiliary and Pancreatic Surgery The prelude to the operation. After 1000 cases, 2000 cases, 3000 cases...to today's 5000 cases,The Department of Hepatobiliary and Pancreatic Surgery has set world records time and time again. Behind these achievements are the unremitting efforts and hard work of the Liu Rong team for thousands of days and nights.
"Surgery has a learning curve. For example, the learning curve of liver resection is about 60~80 cases. If 60~80 cases are not achieved, the operation is not mature, and mistakes are likely to be made. The first 10 cases It’s very easy to make mistakes. Robotic surgery has no sense of touch. It relies on familiarity and replaces sense of touch with vision.” Liu Rong told reporters that it took more than 10 to perform the first robotic pancreaticoduodenectomy. Hour. Later, in the eighth case, Liu Rong suspended the operation and did not restart until a new plan was found two years later. By the time 100 cases were achieved, the operation time had been reduced to less than 3 hours, which was very mature. Similar open surgery requires 4 to 5 hours, and open surgery requires 4 people on the operating table, while robotic surgery only requires an assistant on the table, and the surgeon can operate the robot outside.
"The surgical field of robotic surgery is different from traditional surgery and laparoscopy. The surgical field changes. All technical routes have to be changed, including channel establishment, layout, sutures, etc., which have to go through tortuous exploration. We looked for mathematics, The engineers in the engineering department did calculations for us to find the optimal spatial layout, and made hundreds of cases to form a fixed model, which was promoted nationwide and even globally. When 1,000 cases were achieved, there was no mature domestic and foreign robots for hepatobiliary and pancreatic surgery. Method, so it stood at the forefront of the world.”
Using such new tools, Liu Rong’s team has done a lot of groundbreaking work, and “Rong’s Surgery” is one of them. Traditionally, the pancreas is fixed at both ends, and it cannot be connected again if it is cut off. Therefore, in the past, only pancreaticojejunostomy and pancreaticogastric anastomosis could be performed after tumors of the pancreas and pancreatic neck were removed. The disadvantage is that pancreatic juice and intestinal juice Or gastric juice mixed to form a strong corrosive digestive juice, causing many complications to the patient. However, Liu Rong’s team slightly freed the back of the pancreas and creatively sutured two loops on the margin of the pancreas, which increased the tensile strength of the pancreas by 2.75 times. After the stent was put into the stent for complete butt suture, it also solved the vascular distortion caused by suture. Problems, prevent postoperative blood clots,It grows on its own within a week after stitching. "The diameter of a normal pancreatic duct is only about 2 millimeters. If there is no tool for magnification of 10 times, it is impossible to develop such an operation. Today, hundreds of such robotic operations have been performed, and patients have benefited, and they have been promoted globally. ."
As long as it is beneficial to the patient, it should be mastered.
is the spirit of dare to try, dare to innovate, and never give up. Liu Rong led the Department of Hepatobiliary and Pancreatic Surgery to be in the front, except for the robot hepatobiliary and pancreatic surgery. Surgery, laparoscopic pancreatectomy, laparoscopic hepatobiliary cancer resection, etc., the first cases in many countries were born here.
The laparoscopic anatomical liver resection carried out in 2002, by first blocking the blood vessels in the area to be removed, endoscopic resection of liver tumors without blood supply, reducing the spread of tumors caused by liver turning and blood flow during open surgery The burden has greatly improved the 5-year survival rate of liver cancer. This innovation point won the second prize of National Science and Technology Progress Award in 2014.
"We have requirements for everyone in the team. It does not mean that you only need to master the new tool of robots. For a qualified surgeon, any method that is beneficial to the patient must be Master."
Liu Rong told reporters that robotic hepatobiliary and pancreatic surgery is not suitable for all patients, and it is not a division of laparoscopic and open surgery. "A tumor larger than 15 cm is like looking for a small object in front of a mountain. This kind of surgery is generally recommended to be operated directly. If there is only a 5 cm tumor, it is best to use a robot and a laparoscope. In the case of the gallbladder, the robot has one more hole than the laparoscope, which takes more time and money. The practical laparoscope is the best. So what kind of disease is suitable for what to use, only three surgical methods can be mastered, and it can be based on the difference. The patient finds the best surgical method."
Keep up with the pace of the times and use technology to protect life and health
Where will the future robotic hepatobiliary and pancreatic surgery go? Liu Rong believes that robots are first of all a tool, but with the advancement of technology,In the future, there may be automated robotic equipment to replace some people's work, such as suturing, simple resection operations, or robots for specific diseases or specific operations. It is worth looking forward to. In addition, my country is relatively leading in 5G remote technology, and remote robotic surgery is also a good direction in the future.
Liu Rong believes that ideally, the robot in the future should be a medical control platform rather than a single tool. From surgical design to intraoperative use, supervision, evaluation, to follow-up, Data sorting, etc. should be integrated together to become an important tool and platform in medicine.
"The changes in medical tools are closely related to the latest technological advances. The true modern surgical advancement is related to the first industrial revolution of , after which there were surgical tools such as lancets, pliers, and scissors; second industrial revolution , anesthesia machines, ventilators and other equipment are available only with electrical energy; 's third industrial revolution , the development of information technology, the emergence of laparoscopy in the 1980s and 1990s, now the emergence of artificial intelligence makes robotic surgery possible What will be the changes in the next industrial revolution? As applied science , we should make good use of the achievements of industrial change and information technology, keep up with the pace of the times, and give play to light and heat in life sciences."
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