Learning experience in Cleveland, U.S.A. Published：2013-1-16 Read：1536 times In October 2012, I was honored to be selected by Jiangsu International Exchange Support Program to go to Cleveland Medical Center for training and study. During the training period, I was impressed by the culture construction, team spirit, hardware and software facilities and personal qualities of doctors in Cleveland Hospital. Chang Renan, Department of Hepatobiliary Surgery, Nantong University Hospital, observing laparoscopic liver resection surgery During this training, my study focused on hepatobiliary and pancreatic surgery and liver transplantation. Cleveland has a summer time system, so I took the bus early and arrived at the hospital before dawn, but the conference room was already crowded. The presentations are usually given by residents, and after the presentations there is a lively discussion that gets to the heart of the matter. If it was a research topic, it went into why the study was conducted and what the implications were; if it was a clinical case, it was about why the complication occurred and what would have happened if it had been done differently. I observed the laparoscopic liver resection, where the team repeatedly localized with laparoscopic ultrasound and took great pains until they identified a tiny lesion of only 1 cm. The surgical team adapted to the time and started full laparoscopy plus hand-assisted techniques, which made the operation twice as easy. Excision plus radiofrequency was used to solve all the “suspects”. The surgical team repeatedly studied the imaging film, combined with intraoperative ultrasound, tracking the locking shadow, there is no hiding. The team spirit was evident as the superior doctors analyzed in detail and the subordinate doctors operated carefully, all for the sake of the patient. I was impressed by the well-developed hospital information system. All medical work is recorded in the information system, such as the time the patient and surgeon enter the operating room and the time the skin is cut. All the patient’s outpatient and ward information is integrated into the information system, and all the imaging examinations done outside the hospital are scanned and entered into the information system, so that all the patient’s information is available at a glance when the computer is turned on. Based on these clinical data, clinical researchers can compile and analyze them statistically and draw many meaningful conclusions, making it easy to publish clinical research articles. Meticulous Liver Transplantation Cleveland Medical Center does a great job in liver transplantation and has one of the highest annual numbers of procedures in the nation. There is a strong team for liver transplantation. Especially in living liver transplantation, the manpower and resources required for donor liver extraction, donor liver revision, and recipient surgery are enormous. First of all, the donor surgery must be safe, and the operation is particularly delicate, all done under a magnifying glass. To determine the amount of liver cut, the surgeon repeatedly studies the image film, uses a 3D simulation pen, and outlines the amount of liver cut on the computer. The key is to generally cut the right half of the donor’s liver to ensure the safety of the donor, but also to ensure that the volume of the donor liver is sufficient to play a role in the efficacy of the liver transplant. The surgeons repeatedly used an intraoperative ultrasound probe to detect the course of the middle hepatic vein and sever the liver tissue immediately to the right of the middle hepatic vein. They operated meticulously under shadowless lights, asking the nurses for sterile paper and pens when they encountered problems, scratching out the schematics they envisioned on the table, and striving for complete communication. There is no natural absolute authority in the surgical team; the only difference is the level of experience and the different perspectives of consideration. And all of this gives the residents ample opportunity for the young physicians to have plenty of stamina and energy, and they are often awakened from their sleep at night by the Call machine to begin the liver transplant at the hospital. Because most drivers in the U.S. sign consent forms for post-life organ donation, and so many others who volunteer to donate organs post-life, if there is a sudden accident and they are declared brain dead, the organ harvesting team is notified immediately after cutting up the organs. At the same time, patients on the liver transplant waiting list were notified to come to the hospital for surgery and the surgical team was all mobilized. The Fellow on duty knows where each team member is going and has the authority to arrange everything, even though he or she is not a senior Staff member. everything is done in an orderly manner. Strong Digestive Disease Institute Cleveland Medical Center’s Digestive Disease Institute, or DDI, is ranked second in the nation and includes gastroenterology and general surgery, along with hepatobiliary and pancreatic surgery, the Liver Transplant Center, and colorectal surgery, making it a large group so that medical and surgical departments are combined, and for the same disease, medical and surgical doctors can sit down together and discuss solutions. Crohn`s disease, for example, is a common disease in the United States, and is treated by a combination of medical and surgical means, or a combination of internal and external means. Such a combination of internal and external treatment facilitates the patient’s access to care, and the patient can be transferred from internal medicine to surgery and from surgery to internal medicine in a timely manner. Many diseases that originally required surgical treatment can be solved by medical means. Prof. Bo Shen, a distinguished alumnus of Tong University, has a deep knowledge of Crohn’s disease at Cleveland Medical Center, and especially has unique experience in the endoscopic treatment of end ileal stenosis introduced by him, which has solved many problems that would otherwise require surgical solutions. Many endoscopic incision or dilatation treatments resulting in intestinal perforation can also be repaired surgically in time. That’s why internists can often be found in the operating room, either watching surgery or consulting with patients. And many diseases are just multidisciplinary to get better treatment. The study in Cleveland has benefited me a lot by opening my eyes to the highest level of medical technology in the world and showing me the direction for my future work. At the same time, I also saw the gap between us and the world’s advanced level. This study made me feel obliged to bring these advanced ideas, methods and technologies to my colleagues around me and to my colleagues in the hospital, so as to promote the common progress of everyone. Chang Renan Ministry of Health Health News Jiangsu Province Health Department Nantong University Sina Netease Baidu Nantong Daily South