Surgeons regard the liver, the largest substantial organ in the body, as a “behemoth”, the bile duct, the most delicate and non-regenerative duct, as a “river of life”, and the pancreas, with its complex anatomy and function and extremely fragile tissues, as a “no-go area” for laparoscopic surgery. “forbidden area”. Regardless of the title, it means that hepatobiliary and pancreatic surgery is the most complicated part of abdominal surgery and the most reluctant “reef” for minimally invasive surgeons to touch. However, in this field, the team led by Liu Rong has made many useful explorations, and many of them have become “world firsts”. Posterior laparoscopic pancreatic surgery is not “no way out” As the beneficiary of the world’s first single-port posterior laparoscopic pancreatic surgery, Ms. Jia, who suffers from pancreatic tail insulinoma, sits on a bed in the Cancer Center of the PLA General Hospital and weeps with joy. The entire laparoscopic surgery took less than 90 minutes, with 20 ml of intraoperative bleeding and an incision of only 2 or 5 cm. The tumor was completely removed and she was able to move around on the ground the next day. Before that, she had gained more than 90 kilograms in weight and had been turned down by hospitals for years because of the high risk of surgery. As Ms. Jia’s chief surgeon, Liu Rong attributed the success of the operation to “the successful application of posterior laparoscopic surgery to pancreatic surgery. Liu Rong said, for a long time, posterior laparoscopic surgery and pancreatic surgery is considered a “no-go” and “minefield” of surgery, and the combination of the two procedures is rarely tried. The reason is that there is no natural space behind the human pancreas, and for the laparoscopic technique, which is “invisible”, no “hole” can be found, so there is no way out; in addition, because the pancreas In addition, because of the deep location of the pancreas, the complexity of the adjacent organs and blood vessels, as well as intraoperative bleeding and postoperative pancreatic fistula and other complications have been high, so far, 90% of pancreatic surgery in China is still carried out in the traditional way. Faced with the dilemma of “no way out” for this kind of surgery, Liu Rong got inspiration from minimally invasive urological surgery. Once a hospital’s urology department damaged the pancreas during a posterior laparoscopic adrenal surgery and asked Liu Rong to consult with them. When he came back, he realized that the “path” taken by minimally invasive urology surgery could be learned from. Liu Rong’s idea was then confirmed in numerous animal experiments: an opening from the back of the body, into the anterior pararenal space, and a “shortcut” to the back of the pancreas was artificially created behind the peritoneum by injecting medical carbon dioxide. “Because there are no large blood vessels or important organs in the retroperitoneal space, there is almost no possibility of harming any adjacent organs as long as the anatomical level is correct.” Liu Rong said that since the pancreas itself is a retroperitoneal organ and the posterior approach is a shortcut to reach the caudal lesion of the pancreas, posterior laparoscopic pancreatectomy is undoubtedly easy, safe and feasible for some occupying lesions at the tail of the pancreatic body. “This procedure not only avoids the interference of traditional open surgery as well as traditional laparoscopic surgery on the abdominal organs and reduces the occurrence of surgical complications such as pancreatic fistula and infection, but also is undoubtedly a new treatment route for patients who have developed abdominal adhesions after previous upper abdominal surgery or who are unable to undergo traditional surgical procedures due to obesity. “ At present, Liu Rong’s team has completed more than 10 cases of retroperitoneal pancreatic surgery, and the related article has been published in the international authoritative journal of minimally invasive endoscopic surgery. This year, Liu Rong and others were invited to give a presentation on related research at the 19th European Congress of Endoscopic Surgery. As the largest digestive organ in the human body, the liver has a special anatomical structure and function, and many scholars have compared the liver to a “blood-soaked sponge”, and hemorrhage and hemostasis are the eternal themes of hepatectomy. Laparoscopic hepatectomy has been considered as a difficult and risky operation. Because of this, from 1994 when the first laparoscopic surgery was performed in China to the end of 2002, less than 20 laparoscopic hepatectomies were performed nationwide, and only partial resection of small lesions at the liver margin could be done. What are the methods to reduce bleeding during liver resection? It took Liu Rong 2 years to find the answer since the first laparoscopic hepatectomy was carried out at the PLA General Hospital in 2002. Liu Rong held up a picture of the distribution of blood vessels in the liver and explained his thinking in detail. “The liver includes portal vein, hepatic vein and hepatic artery, 1 output vessel and 2 input vessels. In the past, to do hepatectomy, it was ‘a handful’ to block the total hepatic portal, but due to the long operation time, it often caused damage to the remaining liver function and prolonged the postoperative recovery time. “ ”And with the magnification of laparoscopy, combined with preoperative imaging, we found that the blood vessels distributed in the liver actually divided the liver into 8 parts, such as left outer, left inner, right anterior and right posterior, and each part has 1~2 blood vessels for blood supply, so that by comparing the liver to be removed and clamping the corresponding blood vessels, bleeding can be targeted and reduced. “ In 2004, Liu Rong pioneered the concept of “laparoscopic anatomical liver resection” in the international arena. Since then, as the problem of bleeding from laparoscopic massive hepatectomy has been solved, the number of domestic patients undergoing the procedure has increased to an average of about 80 per year, and as of 2010, many hospitals, including the PLA General Hospital, have reported more than 300 single-center cases at national meetings. According to the report, “laparoscopic anatomical liver resection” has been written into the book “Hepatocellular Carcinoma” and is widely used in clinical practice. Liu Rong introduced that in the next stage, the research team will also target those clinical problems that are difficult to be solved by existing medical means. For example, to improve the comprehensive treatment effect of pancreatic cancer through the improvement of operation style; to expand the indications for laparoscopic liver resection when technology allows, and to enhance the functional reconstruction such as hepatobiliary duct anastomosis based on the resection of lesions. Innovation must be based on safety For more than 10 years, Liu Rong has led his team to carry out more than 10 technologies such as laparoscopic radical resection of bile duct cancer, laparoscopic re-excision of recurrent liver cancer and retroperitoneal laparoscopic liver resection for the first time at home and abroad, which can be considered as a capable person in technological innovation. In the interview, he kept emphasizing that not innovating is not the same as sticking to the rules, and constant innovation should never be done in a hurry. Innovation is only to create more chances of survival for patients, while safety is the most important cornerstone of innovation, feasibility and efficacy must come second. Liu Rong believes that skilled technical operation and accumulation is the foundation to ensure safety. For different surgical teams and different medical centers, the selection of cases should not exceed their own technical level, and surgical innovation should be pursued under the premise of continuous refinement of operational skills. In the process of technological innovation, it is also extra important to communicate with patients and respect their opinions. Liu Rong said that when patients hear that minimally invasive surgery is less invasive, quicker to recover and less expensive, they often get hot-headed and ignore the indications for surgery or over-optimistically estimate the results of surgery. As a doctor, it is more important to maintain a calm and objective judgment. Before the surgery, we should repeatedly explain to the patient the details, where the benefits are, where the disadvantages are, what problems may be encountered, and what countermeasures will be taken if problems are encountered, in order to obtain the patient’s understanding and cooperation.