When minimally invasive surgery is mentioned in today’s general surgery community, many people think it is laparoscopic surgery, and indeed in the past two decades, laparoscopic surgery has sparked a revolution in technology and thinking in general surgery and the entire surgical community. However, “minimally invasive” and “minimally invasive surgery” have a much larger and deeper proposition and connotation. Minimally invasive” has always been the realm of surgery, a comprehensive concept, or a philosophical relative concept; it is the pursuit of “the smallest possible, and the least possible trauma”, where the “trauma” refers to The “trauma” here does not only refer to physiological and physical injuries, but also spiritual and psychological injuries. Therefore, “minimally invasive” does not only mean small incisions, but also “human-centered” at its core, throughout the medical activities. The aim is to maintain the best internal environmental stability of the patient, to achieve the best medical results with the least trauma to tissues and organs, the lightest systemic inflammatory response, and the most optimal scar healing. The concept of “minimally invasive surgery (MIS)” was first introduced by Wickhann in 1983, but was not widely accepted until 1987 when Mouret, France, successfully performed the world’s first laparoscopic cholecystectomy. Minimally invasive surgery as a technology is a new surgical technique and skill formed by the use of modern high-tech achievements combined with traditional surgical techniques, triggered by the trend of minimally invasive thinking. It is one of the key items and important topics in the development of surgery in the 21st century. It is relative to traditional surgery and is in a sense a technological revolution. The rise of minimally invasive surgery has changed the face of traditional surgical techniques, but does not change the essence of surgery, so minimally invasive surgery is a relative concept, and at the same time minimally invasive surgery is a broad concept. All treatments that are less invasive and can achieve or even surpass the efficacy of traditional surgical techniques belong to the category of minimally invasive surgery. It can obtain less trauma, better stability of the internal environment, more accurate surgical results, shorter hospitalization and better psychological effects than the current traditional surgical procedures. Therefore, there are various forms of options and their development will not be exhausted. “Minimally invasive surgical techniques” are composed of four minimally invasive techniques: endoscopic (fiberoptic) and lumpectoscopic (rigid) techniques in direct imaging techniques, and interventional ultrasound techniques (X-ray mediated, CT mediated) in indirect imaging techniques, plus minimally invasive surgical techniques developed and formed on the basis of conventional surgery (such as hand-assisted The fifth minimally invasive technique, the laparoscopic technique, is a modern surgical technique that combines organically. Minimally invasive general surgery is a branch of minimally invasive surgical techniques, which is an evolving and maturing family of techniques. It can achieve satisfactory clinical results with clear indications and can achieve good social benefits. Due to the emergence and growing maturity of minimally invasive techniques in general surgery, it will surely lead to further prosperity of general surgery. Many scholars, experts predicted that “minimally invasive surgery, genetic and biological engineering, organ transplantation and known as the three main streams of medical development in the twenty-first century”. At present, whether in the international or domestic, a hospital to be among the international and domestic advanced ranks and participate in the competition of the necessary conditions: whether continuous, successful completion of complex organ transplantation; can carry out a variety of minimally invasive surgery and its level of minimally invasive skills. This shows the role and status of minimally invasive surgery. Minimally invasive surgery is presenting in front of us with strong vitality and endless vigor. Understand it? Master it? How to fully and reasonably apply it? Only by truly practicing “minimally invasive surgical techniques” can we bring the least damage, the greatest benefit and the best service to patients. We can really realize the change from technical concept to service concept in the process of general surgery treatment. It reflects the humanistic concept of “people-oriented and patient-oriented” and realizes the new medical model of “bio-social-psychological”. In 1805, Dr. Lichtleiter used a cystoscope, a reflecting mirror and a catheter to introduce candlelight into the patient’s body for observation, thus ushering in the great era of endoscopy, but this genius did not attract much attention from the medical community. The early death of Dr. Lichtleiter brought the technique to a standstill. It was not until 1853 that Dr. Desormeaux in Paris began to use kerosene lamps and magnifying glasses to view the surgical field. Although several improvements were made later, the light-guiding system using light reflection was still not ideal. 1897 Edison brought electric light to mankind and also provided a good built-in light source for the rigid endoscope (designed with a separate water circulation cooling system) invented by Nitze and Leiter. At first, rigid endoscopes were used only for urological examinations, and soon Mikulicz and Leiter invented rigid endoscopes for the upper gastrointestinal tract and safely viewed the patient’s esophagus through them. The gradual miniaturization of the light-guide system allowed for transoral insertion of the endoscope, and by the end of the 19th century, endoscopy had become routine in the upper gastrointestinal tract and directly stimulated the birth of laparoscopy and thoracoscopy. in 1901, Dr. Oskarovich in Russia performed the first endoscopic laparoscopic exploration through a posterior vaginal fornix incision using a frontal mirror and a reflecting mirror, and called it “laparoscopy” (ventroscopy). In the same year, Dr. Kelling in Germany performed laparoscopy in the truly modern sense (celioscopy): air was introduced into the abdominal cavity of the dog through a sterile cotton filter to establish a pneumoperitoneum before inserting a cystoscope for exploration, and described in detail the technique of pneumoperitoneum establishment and access in his paper in 1902 . Laparoscopy was born. Soon after, Dr. Jacobaeus in Stockholm performed a similar examination in 17 patients with ascites and officially named it “Iaparoseopy”. By 1912, Jacobaeus reported 115 cases of laparoscopy and Kelling reported 45 cases, describing the laparoscopic appearance of the liver, peritoneal tuberculosis, and tumors. 1911 Dr. Bertram in the United States inserted a proctoscope into the abdominal cavity through an epigastric incision without the use of a pneumoperitoneum, and his observations were confirmed by subsequent dissection. . Since laparoscopy seemed to have limited therapeutic value at that time as an emerging diagnostic technique, it failed to attract the interest of general surgeons but was widely used by urologists and obstetricians and gynecologists. Over the next 20 years, great progress was made in the development of laparoscopic instruments, which made possible the use of laparoscopy for clinical treatment. The first laparoscopic release of adhesions was performed by Dr. Fervers in 1933, and the use of an electrocautery device indirectly contributed to the spread of CO2 pneumoperitoneum, and the first endoscopic tubal ligation was performed by Dr. Boesch in Switzerland in 1936 using an electrocoagulator. In 1952, Fourestier used glass fibers for endoscopic beam conduction, making high-intensity illumination possible and improving visual clarity. Hopkins and colleagues invented a new type of endoscope that transmitted images through a bundle of bendable fiber optics, a new technology that made the microscopic images clearer, brighter, and more realistic in color. In addition, Hirschowitz, an American gastroenterologist, invented a cheaper, more durable fiberoptic gastroscope in 1957, which accelerated the improvement of endoscopy and laparoscopy. Semma, a German obstetrician and gynecologist, played a crucial role in the development of laparoscopic techniques. He invented the automatic pneumoperitoneum machine that monitors intra-abdominal pressure, the electric knife, the electric sulcus, the irrigator, the endocoagulator and the pelvic simulation trainer. Laparoscopic techniques were controversial during this period due to reports of increased postoperative complications, and Semm’s use of laparoscopy for pelvic surgery achieved promising results when he performed the first laparoscopic appendectomy in 1983, marking the transition from a purely diagnostic technique to a therapeutic one. General surgeons contributed little to the diagnostic laparoscopic application but played a very crucial role in the birth of laparoscopic surgery, and in 1985, Dr. Muhe in Germany performed the first laparoscopic cholecystectomy, drawing on Semm’s success [4]. Unfortunately, this pioneering work did not receive the attention of the German Surgical Society until 1993. In 1987, the first laparoscopic cholecystectomy (LC) was performed by Dr. Mouret in France. This was a landmark operation. Soon news of successful LC surgery came from Paris, Bordeaux, and the United States, and overnight, laparoscopic surgery was accepted worldwide. The current status of minimally invasive surgery in general surgery: Currently, laparoscopic surgery is used in all aspects of general surgery. Not only that, but almost all the surgeries in the category of conventional general surgery have appeared with minimally invasive surgical techniques. I. Endoscopic thyroid surgery In 1986, Gagner reported the first endoscopic thyroidectomy marking the beginning of the era of endoscopic neck surgery. This was followed by the emergence of endoscopic-assisted thyroidectomy through the chest wall or axillary approach, as well as through a small anterior cervical or subclavian incision. The chest wall approach to endoscopic thyroidectomy involves placing the operating trocar in the chest wall without a surgical incision in the neck, resulting in a highly desirable cosmetic result. Because this procedure requires extensive separation of the subcutaneous tissue of the chest wall to create a surgical space, it has been suggested that it is a cosmetic procedure only and does not have minimally invasive features. However, there is a lack of prospective, randomized, controlled studies. Endoscopic-assisted thyroidectomy is performed with a small incision of approximately 1.5 cm in the front of the neck, and thyroidectomy is performed with small, specially designed instruments. Miccoli reported 579 cases of endoscopic-assisted thyroidectomy. The selected cases included thyroid nodules, hyperthyroidism, and low-grade malignant thyroid cancer. The success rate of the procedure was 98.8%. Complications were mainly laryngeal recurrent nerve palsy (1.3%), hypoparathyroidism (0.2%) and bleeding (0.1%). The suitability of endoscopic thyroidectomy for malignant thyroid tumors remains a controversial issue. data from Bellantone suggest that endoscopic thyroid surgery is feasible and safe in some smaller cases of papillary carcinoma. And central cervical lymph node dissection is also feasible. Postoperative ultrasonography, serum thyroglobulin levels, etc. show that the results of endoscopic-assisted surgery do not differ from those of conventional surgery. Minimally invasive breast surgery Minimally invasive breast surgery techniques that have been performed in China include endoscopic-assisted subcutaneous mastectomy, axillary lymph node dissection, and post-mastectomy mammaplasty. They are used to treat gynecomastia, parametrium, and benign and malignant tumors of the breast. For breast lumps, the incision can be made in the areola or under the armpit to achieve an aesthetic and “psychologically minimally invasive” effect. Minimally invasive mastectomy is to extend the needle through a small incision on the surface of the breast through a “subcutaneous tunnel” to the lump, and under the guidance of high-frequency color ultrasound, the blade at the tip of the needle is adhered to the lesion, and the lump is cut into small strips in the breast layer by layer. The lump is then cut into small strips and sucked out of the body with the rotary needle through negative pressure suction. For patients with early stage breast cancer, endoscopic assisted mastectomy can be followed by injection of prosthesis to complete timely breast reconstruction. Minimally invasive techniques in hepatobiliary surgery (1) liver surgery Hepatic artery embolization (TAE/TACE) has become the treatment of choice for unresectable giant, multiple hepatocellular carcinoma, with a 5-year survival rate between 5%-15%, and some patients can get a chance for second-stage surgical resection after TACE. Radiofrequency therapy is an effective and safe high-temperature physical therapy method. Radiofrequency introduction can be via a percutaneous hepatic puncture route or laparoscopically guided. Radiofrequency treatment has good efficacy and low damage for small hepatocellular carcinoma with severe hepatic sclerosis or located in the hilar region near large blood vessels. The combination of radiofrequency technology and TACE can significantly improve the efficacy of treatment for large hepatocellular carcinoma. Ar-helium knife freezing and high power focused ultrasound are also the mainstream of minimally invasive treatment for hepatocellular carcinoma, and classical hepatectomy is still the preferred treatment method; laparoscopic techniques have been successfully used for resection of progressive hepatocellular carcinoma, drainage of liver abscess and drainage of parasitic or non-parasitic liver cysts. In recent years, laparoscopic hepatectomy has become increasingly mature in China, and the scope of resection has evolved from marginal hepatectomy to regular hepatectomy in the past. Larger cases have been reported from several centers. The postoperative mortality rate, complication rate and 3-year survival rate are not significantly different from those of open surgery, and the hospital stay is significantly shortened. (2) Biliary surgery Laparoscopic cholecystectomy (LC) is the most widely performed and mature laparoscopic surgery with the largest number of cases in China. For the management of bile duct stones, endoscopic sphincterotomy can be performed preoperatively, intraoperatively or postoperatively to retrieve the stones, and laparoscopic bile duct exploration can also be performed, and the methods include transcystic duct choledochoscopy to retrieve the stones and bile duct excision to retrieve the stones. Pancreatic surgery Endoscopic techniques are mainly used in the treatment of acute pancreatitis in three aspects: ① laparoscopic cholecystectomy, retrograde cholangiopancreatography and sphincterotomy for gallstone pancreatitis. (ii) Laparoscopic exploration, necrotic tissue removal, and drainage for necrotizing pancreatitis. (iii) Laparoscopic surgery for post-pancreatitis pseudocysts. The development of minimally invasive surgical techniques has been able to replace almost all past surgical treatments for severe pancreatitis. For unresectable pancreatic tumors, laparoscopic techniques can be used to complete tumor staging or perform bile-intestinal diversion surgery. In 2003, Pang-Yu Lu reported the first laparoscopic pancreaticoduodenectomy in China. This technique has been carried out in a few centers since then, and nearly 20 cases have been reported in the literature in China. V. Splenic surgery Minimally invasive techniques in splenic surgery mainly include: laparoscopic splenectomy, partial splenectomy and simultaneous splenectomy with peripancreatic vascular dissection for portal hypertension. Laparoscopic splenectomy is mainly used to treat various hematologic diseases, the more common one being thrombocytopenic purpura. The handassisted laparoscopic splenectomy technique (HALS) allows for less difficult operations, increased safety, shorter operative times, and makes it possible to remove larger spleens. Due to recent insights into spleen function, some authors have begun to explore partial splenectomy techniques to preserve spleen function in cases of traumatic splenic rupture. For superficial splenic trauma, laparoscopic suturing or hemostasis with fibrin glue is also possible. VI. Laparoscopic gastrointestinal surgery (1) Laparoscopic gastric surgery A) Laparoscopic gastrointestinal perforation repair is an earlier procedure carried out after LC. It allows laparoscopic exploration, suture repair, and peritoneal flushing and drainage to promote peritonitis relief. B) Laparoscopic-assisted radical resection of progressive gastric cancer has begun to be promoted. Yu Peiwu reported 71 cases of progressive gastric cancer D2 radical surgery. 69 cases were operated successfully and 2 cases were converted to open surgery. This indicates that laparoscopic D2 radical surgery for progressive gastric cancer is technically feasible and safe for appropriate patients, and can achieve the scope of D2 lymph node dissection and sufficient tumor margins, and the number of lymph nodes dissected is comparable to that of open surgery. C) Laparoscopic gastric diversion or gastric fasciculation has been widely used for the treatment of morbid obesity in Europe and America. D) Laparoscopic fundoplication has been widely used in Europe and America for the treatment of gastroesophageal reflux disease. Most of such patients in China are undergoing internal medicine treatment. However, there are a few reports of this procedure. Qin Mingfang of Nankai Hospital in Tianjin reported 42 cases of laparoscopic fundoplication in 2004 and achieved satisfactory results. E) Endoluminal surgery is a technique in which the laparoscope and its instruments are operated inside the stomach through a percutaneous puncture to establish a channel from outside the body to the stomach. Zhu Jiangfan of Shanghai Oriental Hospital was the first to introduce this technique in China and conducted experiments on animals. In 2004, Yin Li of Shanghai Oriental Hospital reported two cases of endoscopic endoluminal surgery: one case was resection of a mass in the posterior gastric wall, and the other case was a pancreatic pseudocyst with gastric-pancreatic cyst drainage through the posterior gastric wall. Endoscopic endoluminal surgery is difficult and has certain technical bottlenecks. F) Transoral transgastric wall laparoscopic surgery is a new surgical approach being explored in recent years. It involves placing a therapeutic gastroscope through the mouth into the stomach, rinsing the gastric cavity and then making a gastric wall stoma with the special instruments that come with the gastroscope. The gastroscope is then inserted deep into the abdominal cavity through the gastric wall incision and the appendectomy and cholecystectomy are performed with instruments brought through the therapeutic hole of the gastroscope. The resected specimen is removed with the gastroscope through the mouth. No surgical incision is left in the abdominal wall. This technique is currently in the animal experimental stage. Its entry into the clinic is subject to the improvement of instruments and equipment and the continuous maturation of technology. (2) Laparoscopic colorectal surgery Laparoscopic colorectal surgery will increasingly be performed in the surgical management of colorectal diseases. There is a growing consensus that it conforms to the basic principles of oncologic surgery and can achieve the same results as open surgery. One of the main causes of tumor implantation in the incision after laparoscopic surgery is: intraoperative laparoscopic instrument contamination. The results of a study on the effect of laparoscopic surgery on tumor cell dissemination and implantation in colorectal cancer showed that CO2 pneumoperitoneum did not cause tumor cell dissemination. The understanding that laparoscopic surgery does not increase tumor cell dissemination and implantation is largely clear. Seven, the application of laparoscopy in the diagnosis and treatment of abdominal bed TV laparoscopy has obvious advantages in the diagnosis and treatment of abdominal trauma: (1) clear diagnosis and treatment of most patients with hemodynamically stable abdominal trauma under direct vision, avoiding unnecessary open abdominal exploration. (2) Clear preoperative diagnosis and reduced rate of negative dissection surgery. (3) It enables the operator to have a clear picture of the injury and guides the selection of incision and operation style. However, there are still obvious limitations of TV laparoscopy for abdominal trauma: (1) Patients with post-traumatic hemodynamic instability are contraindications to laparoscopic exploration. ②The diagnosis and treatment of retroperitoneal trauma by laparoscopy is still worth exploring. (iii) The ability of laparoscopy to manage abdominal organ injuries is still constrained by the instrumentation. Therefore, the exploration of abdominal trauma by TV laparoscopy should strictly master its indications and contraindications, grasp the indications and timing of intermediate open abdomen, and give full play to the advantages of laparoscopic acute abdominal exploration. In 1989, Lichtenstein proposed a new concept of tension-free hernia repair, and the successful use of patches also led people to consider the possibility of using laparoscopy for hernia repair. Laparoscopic transperitoneal preperitoneal patch implantation (TAPP) and laparoscopic complete extraperitoneal patch implantation (TEP) are mainly carried out in China, and these two procedures have been rapidly promoted because of their reasonable operation and low early recurrence rate. Although laparoscopic hernia repair has the advantages of less trauma and less pain, it also has the reasons of requiring general anesthesia and higher cost, and has obvious advantages and shortcomings compared with other tension-free methods. The future of minimally invasive general surgery The development trend of minimally invasive surgery will likely be developed in the following aspects: the comprehensive and systematic development of various different minimally invasive techniques and the continuous integration between techniques; the fully integrated use and rational selection of existing minimally invasive techniques in a certain disease; the innovative development of new technologies, mainly in (1) robot and remote operation surgical robot system in minimally invasive surgery (2 ) virtual reality technology in minimally invasive surgery: virtual reality (VR) refers to the realization of a virtual environment that people can feel through sight, sound, touch and smell with the help of computer technology and software and hardware equipment. In the field of minimally invasive surgery, it can be used not only for the design of surgical plans and surgical training, but also directly for the implementation of surgery. Virtual reality technology has the ability to simulate the visual feedback, haptic feedback and inverse feedback information in real surgery. In particular, its 3D reconstruction function is uniquely advantageous in surgical positioning and surgical navigation. (3) Micron/Nanoscience and Micron Technology in Minimally Invasive Surgery: Swedish scientists have recently invented a nanoscale micro-robot, which is expected to be a new type of microsurgical tool and microbiomedical detection tool. The micro-robot developed by Nankai University can “inject” cells, allowing them to be genetically transformed in less than a minute. In the field of surgery, one of the most exciting advances of the future may be the introduction of new surgical video navigation systems. The integration of computer technology and data output technology can produce three-dimensional, virtual solid surgical images that help surgeons accurately understand the microscopic anatomical relationships (e.g., blood vessels, intrahepatic bile ducts) and locate lesions before separating tissue. Using this technology, procedures that cannot be performed with conventional general surgery or are extremely risky can be performed. It is believed that soon, the new surgical navigation system will be used in clinical practice. The scene at cover time is the patient lying on an operating table equipped with an MRI image monitor, and the operator sitting in front of a computer operating the robot for the procedure ……