With the continuous development of hepatobiliary surgery technology，it has entered the era of minimally invasive surgery. Anatomical liver resection is the soul of the clinical application of minimally invasive liver resection. With the rapid development of laparoscopic technology and the further development of the dynamic watershed theory of the liver，the necessity of anatomical liver resection has become increasingly prominent. However，there is still a lack of precise definition of the anatomical scope and specific anatomical landmarks for liver resection. Therefore，we clinically summarize the key points，lines and planes in the implementation process of anatomical liver resection，aiming to guide more precise anatomical boundaries for the clinical practice of laparoscopic liver resection and facilitate the standardization and technical promotion of anatomical liver resection.
To compare the differences in short-term outcomes between robotic-assisted and laparoscopic-assisted mesorectal excision for primary rectal adenocarcinoma.
Methods
A retrospective observational cohort was established，including patients who underwent robotic-or laparoscopic-assisted mesorectal excision at the First Affiliated Hospital of Nanjing Medical University from Jul. 2016 to Aug.2018. The outcomes included surgical outcomes，pathological outcomes，overall survival （OS），time to recurrence （TTR），and prognostic risk factors for OS ant TTR.
Results
After propensity score matching，each group was assigned 81 patients. Compared with the laparoscopic group，the operative time of the robotic group was 16.2 min longer （133.3 min vs. 117.1 min， P=0.007） and the postoperative hospital stay was 0.9 days shorter （8.4 days vs. 9.3 days， P=0.048）. No statistically significant differences were observed between the two groups in terms of conversion rates to open surgery，postoperative short-term complication rates，numbers of harvested lymph nodes，OS，and TTR. The maximum diameter of the tumor and pathological TNM stages were prognostic factors for OS and TTR，respectively.
Conclusion
Compared with laparoscopic-assisted surgery，the robotic-assisted mesorectal excision for rectal cancer was associated with longer operative time and shorter postoperative hospital stays. Regarding pathological outcomes and survival outcomes，more clinical studies were required to investigate the potential advantages of robotic surgery.
To compare the long-term efficacy of endometrial radiofrequency ablation（CardeaTM） and transcervical endometrial resection （TCRE） in the treatment of heavy menstrual bleeding（HMB）.
Methods
A prospective multicenter study enrolled 156 premenopausal women diagnosed with HMB and without desire for future fertility. Participants were randomly assigned to receive either endometrial radiofrequency ablation （CardeaTM，experimental group， n = 80） or transcervical endometrial resection（TCRE，control group， n=76）. The primary outcome measure was the reintervention rate at 10 years posttreatment. Secondary outcome measures included efficacy rate，amenorrhea rate，and adverse event rate at 3，6，and 12 months post-treatment.
Results
The 10-year reintervention rates were 10.8% and 14.5% in the experimental and control groups，respectively （P = 0. 61）. No statistically significant difference in efficacy rates was observed between the two groups at 3，6，and 12 months post-treatment. However，the amenorrhea rate was significantly higher in the experimental group compared to the control group at 3，6，and 12 months （HR，0. 53； 95% CI，0. 31-0. 9； P = 0. 02）. Five patients were unable to complete the endometrial radiofrequency ablation procedure.
Conclusions
Endometrial radiofrequency ablation demonstrates a low long-term reintervention rate and achieves a high amenorrhea rate in the short term，making it a preferred treatment option for HMB in women without a desire for future fertility.
To study the appropriate patient selection and surgical techniques for laparoscopic interval debulking surgery （IDS） after neoadjuvant chemotherapy （NACT） for advanced ovarian cancer.
Methods
The clinical，surgical，pathological and follow-up data were collected from patients with advanced ovarian cancer who met the criteria and underwent laparoscopic IDS after NACT.
Results
From Mar. 2023 to Dec. 2023，six patients underwent laparoscopic IDS after 3 courses of NACT at the department of gynecology，The First Affiliated Hospital of Nanjing Medical University，and all of them achieved R0 resection with a mean operative time of 405 ±42 minutes and intraoperative bleeding of 283 ±194 ml. Two patients were transfused due to preoperative moderate anemia and intraoperative bleeding of more than 400 ml. The median interval between the first postoperative chemotherapy and IDS was 13 days. None of the patients suffered from Clavien-Dindo grade Ⅱor higher complications within 30 days after surgery. After 6 months of follow-up，no patient had recurrence or died.
Conclusions
Laparoscopic IDS allows for the selection of adequately evaluated patients and is performed by an operator with extensive experience in open cytoreduction surgery and good laparoscopic surgical skills，achieving satisfactory tumor reduction while reducing trauma and facilitating postoperative recovery.
To investigate the feasibility and safety of flip method transvaginal natural orifice transluminal endoscopic surgery（vNOTES） adenomyosis foci resection.
Methods
The clinical data of 6 patients with adenomyosis admitted to the Department of Gynecology of Kelamayi Central Hospital from Jul. 2024 to Sept. 2024 were reviewed，and the experience was summarized.
Results
The median age of the patients included in the study was 44. 5 years （38-48 years），and the mean BMI was 21. 30 ±1.18 kg/m2. All patients underwent successful resection of adenomyosis foci by the vNOTES reversal method，with a median operative time of 3.22 h （2.25-3.92 h），a median operative bleeding of 140 ml（50-600 ml），and 1 patient with blood transfusion （17%，1/6），1 patient with delayed healing of vaginal incision （17%，1/6），first postoperative menstrual PBAC score of 97 （14-110），first postoperative dysmenorrhea median VAS of 2 （0-5） were lower than preoperative levels，and none of the patients had intestinal injuries，ureteral or bladder injuries，postoperative infections，blood leakage from vaginal incision，infection of the severed end of the vagina，or incision dehiscence，complications such as abnormal vaginal discharge and lower abdominal pain.
Conclusions
The flip method of vNOTES adenomyosis foci excision is a safe and feasible surgical route，with favorable results in the near future.
To assess the impact of endobronchial valve （EBV） treatment on lung function，exercise tolerance，clinical symptoms，and quality of life in patients with advanced emphysema，and to evaluate the clinical efficacy of EBV in patients with severe emphysema.
Method
From Sep. 2010 to Oct. 2022，patients with advanced emphysema who received EBV treatment in 15 hospitals in China were enrolled in this study. Clinical data and chest high-resolution CT imaging data were collected and used to establish a clinical database and an imaging database. The changes in lung function，exercise tolerance，clinical symptoms，and quality of life before and after treatment were analysed and the response rate of EBV treatment was calculated.
Result
136 patients diagnosed with advanced emphysema who received EBV treatment were included in this study. Of these patients，131 were male and 5 were female，with an average age of 60 ±8 years. The results indicated a significant improvement in the patients′ pulmonary function，exercise tolerance，clinical symptoms，and quality of life following treatment. Additionally，64.71% of cases had a TLVR≥350 ml，and 55.15% of cases achieved the minimal clinically important difference （MCID）in FEV1 improvement （≥12%）. EBV efficacy was more pronounced in patients with TLVR≥350 ml，but 36.36% of patients with significant volume reduction did not obtain significant improvement in FEV1.
Conclusion
EBV treatment can improve lung function，exercise tolerance，clinical symptoms，and quality of life in patients with advanced emphysema. However，treatment response rates are still unsatisfactory.
To investigate the application of da Vinci robot-assisted local resection of pancreatic head tumor plus end-to end pancreas anastomosis in the treatment of cystic pancreatic head tumor，and the prognostic advantages of traditional operations compared with pancreaticoduodenectomy.
Methods
The patient was diagnosed with cystic tumor of the head of pancreas in Panzhihua Central Hospital，combined with relevant literature，and fully communicated with the patient′s family，and underwent da Vinci robotassisted local resection of the head of pancreas tumor plus end-to-end pancreatic anastomosis.
Results
The patient recovered smoothly after surgery，and the postoperative pathology proved that the pancreatic head tumor was intraductal papillary mucous tumor with focal high-grade intraepithelial neoplasia. After surgery，the patient did not develop grade A or B pancreatic fistula，biliary fistula or infection，and was given symptomatic supportive treatment such as anti-inflammatory，inhibition of pancreatic enzyme secretion，and fluid rehydration. He was discharged 10 days after surgery，and the pancreatic duct was pulled out under gastroscopy 2 months after surgery.
Conclusion
In the treatment of benign or low-grade pancreatic head tumors，da Vinci robot-assisted local resection of pancreatic head tumor plus end-to-end pancreatic anastomosis has the advantages of less trauma，faster postoperative recovery and higher quality of life，and has certain advantages over traditional operations such as pancreaticoduodenectomy.
To investigate the application of electric hook in laparoscopic sleeve gastrectomy.
Methods
A retrospective analysis was conducted on the clinical data of one patient who underwent laparoscopic sleeve gastrectomy with an electric hook at Yibin Second People′s Hospital in Jul.2022. The electric hook was used throughout the operation to separate the gastric artery，gastric short artery，and the gastric mesenteric artery and gastric short artery were ligated during the repositioning of the omentum.
Results
The total operation time was 63 minutes，and the intraoperative blood loss was 3-5 ml.The postoperative pain score was 3，nausea and vomiting score was 2，and the patient discharged 4 days after surgery.
Conclusion
The electric hook can meet the requirements of laparoscopic sleeve gastrectomy under reasonable operation，not only saving medical resources，but also reducing the surgical costs for bariatric surgery patients.
To explore the application of laparoscopy in the treatment of intussusception failed by air enema，and to improve clinicians'understanding of secondary intussusception.
Methods
In the short-term recurrence of intussusception and air enema failure，combined with relevant literature，after full communication with the patient′s family，single-channel laparoscopic assisted intussusception reconstruction treatment was performed.
Results
Postoperative recovery was smooth，and postoperative pathology confirmed that the patient had an ectopic pancreas in the ileum，with alveolar and ductal structures seen in the gland. The child resumed liquid diet on the 4th postoperative day，with no adverse reactions such as vomiting and abdominal distension，no complications such as anastomotic leakage and stenosis，and was discharged from the hospital on the 6th postoperative day.
Conclusions
Laparoscopic treatment of intussusception has the advantages of less trauma，faster postoperative recovery，and good cosmetic results，compared with traditional open surgery.
Since the 1980s，the emergence of laparoscopic surgery has marked a new era of meticulous attention to detail in surgical procedures，moving away from the traditional“big shot” approach.Today，minimally invasive surgery has gone deep into the entire surgical diagnosis and treatment process，enabling patients to achieve precise，refined，and individualized surgical concepts. Therefore，laparoscopicrelated techniques have become necessary for general and even all surgeons. However，there are currently differences in the training of laparoscopic surgeons between domestic and international，and there are also many inconsistencies in the training of laparoscopic surgeons in different regions of China，lacking a unified quantitative standard. This article summarized the current status and development trends of laparoscopic surgery training at home and abroad，as well as the laparoscopic training program of our research group，through a literature review.
Rectal tumors located within 2 cm from the dentate line are classified as ultra-low rectal cancer，with surgery being the primary treatment approach. In patients who have ultra-low rectal cancer invading the levator ani muscle or anal sphincter，abdominoperineal resection （APR） or extralevator abdominoperineal excision （ELAPE） are the most common surgical procedures performed. The “surgical waist” is an unavoidable issue with APR. In spite of ELAPE's ability to remove more levator ani muscle tissue，which reduces intraoperative perforation and local recurrences，it poses the greater challenge of reconstructing the pelvic floor. In recent years，There have been various modifications made to ELAPE in terms of surgical approach and positioning that have achieved satisfactory results in clinical applications，however the anus has not yet been preserved. As anatomical research and laparoscopic technology advance，sphincter-preserving surgeries such as intersphincteric resection （ISR） and transanal total mesorectal excision （taTME） have been increasingly performed. It is important to note，however，that sphincterpreserving surgeries have higher technical demands，a longer learning curve，and postoperative complications as well as long-term oncological outcomes still need to be evaluated clinically. The aim of this article is to review the research progress of surgical treatments for ultra-low rectal cancer，to provide clinical physicians with a reference for selecting appropriate surgical treatments.
Endometriosis （EMs） is a common benign gynecological disease that seriously affects women′s health. Surgical treatment is one of the important treatments. But it often involves multiple tissues and organs such as the uterosacral ligament，intestine，ureter，or bladder，and there is no precise method to assist the surgeon to remove the lesion safely and completely. In recent years，it has been reported that indocyanine green （ICG） fluorescence imaging can be used in the surgical treatment of EMs，assisting in the identification of the location of the lesion and the boundary of the lesion resection during surgery，improving the safety and thoroughness of the operation，and reducing the complications related to surgery. This review aims to introduce the application of ICG fluorescence imaging in minimally invasive surgery for EMs，and provide guidance for the clinical promotion and application of this technology.
