Objective

To standardize and promote the clinical application of pancreatic duct(repair) surgery for benign and borderline/low-grade malignant pancreatic tumors, thereby improving surgical outcomes and reducing complications, this expert consensus was formulated.

Methods

Organized by the Minimally Invasive Surgery Committee and Intelligent Medicine Committee of the Chinese Research Hospital Association, domestic pancreatic surgery experts discussed key topics including pancreatic duct anatomy, repair concepts, surgical indications, preoperative evaluation, intraoperative techniques, and postoperative management, integrating literature evidence and clinical experience.

Results

The consensus delineates core techniques of pancreatic duct repair surgery, such as main pancreatic duct repair, end-toend pancreatic anastomosis, main pancreatic duct replacement, and branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) local resection. It emphasizes preoperative multimodal imaging evaluation,intraoperative ultrasound guidance, and minimally invasive approaches. Recommendations include selecting repair strategies based on duct injury severity, standardized use of pancreatic stents, and postoperative pancreatic fistula prevention protocols.

Conclusion

Pancreatic duct (repair) surgery restores duct continuity, avoids traditional gastrointestinal reconstruction, and significantly reduces postoperative complications. It represents a major advancement in organ-preserving pancreatic surgery. Further studies are needed to validate long-term efficacy and refine technical details.

阴道内镜技术是Bettocchi和Selvaggi^[1]在1997年提出的门诊宫腔镜置镜的一门技术。阴道内镜检查或非接触式宫腔镜检查是指不在阴道内放置窥器、不钳夹宫颈、不使用扩宫棒扩张宫颈，直接将宫腔镜经阴道口置入阴道，通过镜体与膨宫介质的双重扩张，将镜体通过颈管置入子宫腔的宫腔镜置镜技术^[2]。该技术发展至今，已有大量的文献报道证实了其安全有效性，在完成传统宫腔镜检查的同时，显著减轻患者疼痛、简化手术流程，在熟练掌握后可以很大程度拓宽宫腔镜的适应证^[3,4]。此外，随着宫腔镜手术器械的不断更新换代，镜体外径逐渐纤细化，阴道内镜技术同样可应用于宫腔镜手术治疗过程^[5]。由于它既符合经自然腔道内镜手术(NOTES)理念，同时又拓宽了传统宫腔镜手术的适应证，尤其给处女、婴幼儿、生殖道萎缩或畸形等患者带来福音，所以美国妇科腹腔镜学会(AAGL)、美国妇产科医师学会(ACOG)、英国妇科内镜学会和英国皇家妇产科医师学院均提倡将阴道内镜技术用于门诊宫腔镜的诊疗过程^[6]。

Objective

To standardize robotic radical resection for perihilar cholangiocarcinoma and improve perioperative safety and long-term survival of patients, this expert consensus is formulated.

Methods

The Minimally Invasive Surgery Professional Committee and the Intelligent Medicine Professional Committee of the Chinese Research Hospital Association initiated and organized experts in minimally invasive surgery for biliary tract tumor in China. This expert consensus was drafted based on literature and practice,followed by several rounds of voting, feedback, discussion and revision.

Results

Eleven recommendations were put forward covering six aspects of this operation including preoperative evaluation and surgical planning, indications and contraindications, perioperative safety and efficacy, feasibility of cases requiring vascular reconstruction, survival and recurrence, as well as learning curve.

Conclusion

After thorough evaluation and comprehensive planning, it is safe and eligible for surgical centers with adequate experience in robotic hepatobiliary and pancreatic surgery to carry out this operation. The advantages of robotic approach over other approaches in terms of complications, prognosis and learning curve, still need to be supported and clarified by evidence with higher quality obtained via more application and practice.

Objective

To standardize robotic radical resection for gallbladder cancer thereby reducing postoperative complications and improving patient prognosis, this expert consensus is formulated.

Methods

The Minimally Invasive Surgery Professional Committee and the Intelligent Medicine Professional Committee of the Chinese Research Hospital Association initiated and organized experts in minimally invasive surgery for biliary tract tumor in China. Based on literature and practice, this expert consensus was drafted,followed by several rounds of voting, feedback, discussion and revision.

Results

Fourteen recommendations were put forward in five aspects of this operation including preoperative evaluation and surgical planning,indications and contraindications, perioperative safety and efficacy, survival and recurrence as well as learning curve.

Conclusion

It is safe and effective for surgical centers with adequate experience in minimally invasive surgery to carry out robotic radical resection for gallbladder cancer following thorough evaluating and surgical planning. The advantages of robotic approach over other surgical approaches in terms of efficacy, prognosis and learning curve, still need to be confirmed and revealed by studies with higher quality.

Recently, transvaginal natural orifice transluminal endoscopic surgery(V-NOTES)has been developed rapidly in the field of gynecology, with the advantages of no scar, less trauma and quick recovery, and it has been widely used in adnexectomy, hysterectomy, myomectomy, pelvic organ prolapse surgery, gynecological malignancies surgery and others, this article will review the current status, limitations and advantages of V-NOTES in various gynecological diseases based on research progress at home and abroad.

The fluorescence imaging system under laparoscopic surgeries can provide a fused vision of fluorescence and conventional white light. Surgeons can have a more intuitive and three-dimensional image perception of the intraoperative anatomy. Indocyanine green (ICG) is the most common used clinical fluorescence imaging agent used in the field of general surgery. It has accurately marked tumors and surgical margins, demonstrated sentinel and lymph nodes in tumor drainage area, and identified metastases. Thus, ICG has the ability to improve surgical efficiency, increase perioperative benefits, reduce postoperative complications, and to provide protection and guidance for surgery. This review summarized the application of ICG fluorescence imaging in laparoscopic surgeries, including gallbladder and biliary tract surgeries, gastrointestinal surgeries, pancreatic surgeries, and thyroid/parathyroid surgeries. Recent advances are reviewed to provide future perspectives for laparoscopy fluorescence imaging, including 3D stereoscopic imaging, multicolor gradient fluorescence, and new fluorescent agents.

切除与重建是外科手术两项重要的组成部分，其中重建在保证器官功能性和生理性方面有不可代替的价值。外科的重建可分为空腔对空腔、实质对空腔、实质对实质三大类重建方式。良好的重建质量直接决定了术后并发症的发生率，对于提高患者近、远期的生活质量具有重要意义^[1]。腹腔镜和机器人下重建技术的不完善也是制约微创外科发展的重要原因。以胰十二指肠切除术为例：在切除完成后，需要实施胰肠、胆肠及胃肠三个吻合来重建消化道，不仅操作复杂，而且术后任何一个吻合出现愈合不良，都会引起胰漏、胆漏、消化道漏等术后并发症，甚至导致患者死亡^[2]。自1889年Codivilla实施首例胰十二指肠切除术后的100多年间，外科医师们在吻合顺序、重建方式和手术技巧方面不断进行着各种创新和改良，一定程度上减少了胰漏、胆漏等并发症。但到目前为止，仍然没有一种重建方式能够完全避免消化道漏的发生。由于每一例患者的体型、胰腺质地、胰管和胆管直径、炎症状况都是不同的，重建方式和技术方法需要在保证规范操作和组织愈合原则的基础上强调个体化操作。因此，从纷繁复杂的重建方式中找到统一的核心逻辑就显得尤为重要。笔者在总结开腹、腹腔镜和机器人手术中消化道、实质器官及血管重建经验的基础上，结合重建后不同组织生理性愈合的原理，提出了低张力低应力重建的理念，希望通过该理念的提出，进一步优化外科重建技术，促进重建后组织尽快从机械性的力学愈合达到功能性的组织学愈合，降低重建术后并发症的发生。

Hepatectomy is an effective way to solve most liver space occupying diseases. Robot assisted hepatectomy is the combination of hepatectomy and the latest science and technology. Compared with many limitations of traditional laparoscopic technology, including limited operating angle, physiological tremor, poor ergonomics and difficult two-dimensional image adaptation, the robotic surgical system has the advantages of high-definition 3D field of vision, multi degree of freedom instrument design and fine operation, which is conducive to the treatment of hilar, reduce intraoperative injury and accelerate postoperative rehabilitation. This paper will discuss the clinical application and progress of robot assisted hepatectomy in benign and malignant liver diseases and liver transplantation, so as to provide reference for further research of hepatectomy.

手术采用单腔气管插管全身麻醉，患者取平卧分腿位，气腹针脐周穿刺建立二氧化碳人工气腹，气腹压力12 mmHg(1 mmHg＝0.133 kPa)，实施单孔腹腔镜手术(single-incision laparoscopic surgery，SILS)加一孔(SILS+1)腹腔镜手术。采用胃大弯入路，遵循肿瘤整块切除的原则，按照游离大网膜→幽门下区淋巴结清扫→悬吊胃和肝→幽门上区淋巴结清扫→胰腺上缘区淋巴结清扫→游离胃小网膜上部后缘→脾门区淋巴结清扫的顺序进行胃周淋巴结清扫手术，解除胃悬吊线。转向小弯入路，游离小网膜囊肝侧，继续游离胃小网膜上部前缘，再游离胃大网膜上部分。直线切割闭合器离断十二指肠和胃，从单孔取出标本，重建气腹，行残胃-十二指肠三角吻合重建消化道。

Laparoscopic partial splenectomy （LPS），a minimally invasive surgical procedure，has gained increasing popularity in the treatment of splenic diseases. With advances in the understanding of splenic function and the widespread adoption of “precision medicine” and “enhanced recovery after surgery（ERAS）” principles，LPS has become the preferred surgical option for benign splenic lesions，selected hematologic disorders，and minor splenic trauma. LPS not only preserves spleen function，but also has advantages such as safety，damagecontrol，mildpain，and fast recovery. Thisconsensus，based on the latest research and clinical practice，outlines the indications，contraindications，surgicaltechniques，and postoperative management of LPS，accompanied by expert recommendations to guide clinical practice. It is intended for patients undergoing LPS and designed for use by surgeons，nurses，and healthcare professionals across all levels of medical institutions.