It was another sunny summer day, the weather was exceptionally hot, and although the fans kept blowing at night, there was always the feeling that drinking sugar water did not quench my thirst. I came to the hospital operating room before eight o’clock in the morning. Foreigners usually come to work early and check the room at six o’clock, and enter the operating room at seven thirty. Today was a robot-assisted lobectomy of the liver, which I had been looking forward to for a long time! Everything was ready for the surgery, the robotic arm was fitted with a sterile isolation sleeve, intraoperative ultrasound, Ligasure, Endo-G were all available, and other disposable accessories were even more dazzling. The surgery officially started with TSUNG, the chief of surgical oncology and a young Chinese associate professor, in charge! The patient’s legs were divided and catheterized. They are not very complimentary sterilization, haphazardly scratched on the abdominal wall a few times, this must be in the country must be scolded by the professor, but foreigners surgical sterilization are like this, and not much antibiotics after surgery, is a preoperative injection, once within 24 hours after surgery, including WHIPPLE also the same, sometimes feel that they are really bold! The surgery is performed by the six-hole method, in which the first hole is punched in the left axillary anterior line under the rib arch and placed under direct vision with a 5 mm zero-degree mirror, which is safe and reliable, while the other holes are distributed around the umbilicus, which is different from our traditional lumpectomy liver resection cloth holes. Foreigners attach great importance to the deployment of the holes, which is usually decided by the professor himself, often far away from the surgical field, to give full play to the advantages of lumpectomy instruments! There are three members of the surgical team. First, the round and sickle ligaments of the liver are separated with LIGASURE, and this operation is done by a second assistant standing between the legs. Then the hepatorenal ligament was separated by the first assistant standing on the left side of the patient. Then the deltoid and coronary ligaments are freed, which is done by the main surgeon standing on the right side of the patient using an electric hook! Now the freeing approached the inferior vena cava, the main operating hole was changing, and the electric hook and LIGASURE were used alternately, with particular care in the treatment of the short hepatic vein, where the first assistant reached into the instrument from the left side to lift the right liver to the left, fully revealing the posterior liver, which was critical! One short hepatic vein was cut after freeing it and clipped after going on the titanium clip, with two too clips on the retained side. I don’t think it’s that reliable, personally I think it’s better to tie a knot. Continue to free the right hepatic vein upwards, ready to free the right hepatic vein, at this time the posterior inferior hepatic cavity has been fully revealed, in the high-definition screen can see its non-stop fluctuation with the heartbeat pup! At this point the lens was replaced with a 5 mm 30 degree lens to reveal the inferior vena cava of the trunk and a 5 mm puncture device was placed under the saber and it was used as the main operation hole to try to free the right hepatic vein! tracor, the robotic arm was placed from the cephalad side, with arms 1 and 3 on the left and arm 2 on the right. The robot operated instruments were installed and the advantage was immediately evident, with 7 joints moving at any angle to operate in the narrow space behind the liver with ease! The lowermost short hepatic vein is now being dissected and, as expected, the knot is tied proximally, which is much more convenient than conventional lumpectomy! The proximal hepatic side is also tied with a silk knot and a hemilock on both sides, so it’s foolproof! The short hepatic vein is now treated by freeing it along the inferior vena cava, which is much easier to do with the hemilock clamp under the robot! Now the main surgeon professor sits at the console to operate, he looks at the 3D stereoscopic field of view, magnified about ten times, indeed the hierarchy, while the first assistant stands between the patient’s legs to help change the operating instruments. The main surgeon controls the lens movement and the conversion of the field of view, which not only increases the stability of holding the mirror, but also allows the operator to adjust the orientation and angle of the operative field at any time according to his own ideas. In addition the operator-controlled third arm can help to reveal the operative field, steadily and tirelessly. (insert general introduction) The modern robotic operating room is 2-3 times larger than a normal operating room and is equipped with at least 4-5 monitors and a full surgical recording system. In addition, there are two large monitors on two walls to monitor the comfort of the confluence of the yin and yang mother softshells embedded in the air private food cheeks to eat the nasal escape from the nightmare arthroscopic liver resection of the upmc is not as much as one would think, with the discrepancies advertised on their website, today or I came to the United States to see the first lumpectomy liver resection! Most of their liver resections are still open surgery, the anatomy of the hepatic hilum is very detailed, the liver is basically routinely separated from the blood flow in and out of the liver before breaking, endo-G is also often used tools, an average of about 10 per unit, really spare ah! Suddenly, during the dissection process, there was bleeding from the short hepatic vein, which was tied with 3-0 PROLENE sutures. This is more difficult to accomplish under conventional lumpectomy! It was time to start removing the gallbladder. In terms of simple cholecystectomy, using the robot was a bit of a cannon shot, not much of an advantage, but it could be used as a beginner robot for practice! The gallbladder is strategically removed, and the main purpose is to dissect the first hepatic portal, free the right branch of the portal vein, the right hepatic artery and the right hepatic duct, similar to open surgery! At this point the right hepatic artery is revealed and free and the surgeon completely opens the fascia on its surface while exposing the right branch of the portal vein posteriorly. The right hepatic artery was prepared for dissection with a stapler, which was unsuccessful because the space was too small. It was still cut with a silk ligature and a hemilock on each of the distal and proximal ends. The right branch of the portal vein was isolated and dissected with a stapler, followed by a ligation of the nodal tissue leading to the right liver. Free the right hepatic duct, ligate and disconnect! The robotic arm is withdrawn, the right hepatic vein is freed and suspended, and the superior stapler is dissected, at this point almost parallel to the inferior vena cava, with three rows of staples firmly and neatly at the dissected end of the right hepatic vein. The analysis robot is mainly used for dissecting the tip a hepatic portal and dealing with the short hepatic vein, the remaining steps can be done completely with conventional lumpectomy! The right liver was completely free and the blood flow in and out of the liver was completely disconnected, and a clear ischemic demarcation line appeared on the surface of the liver. At this point, intraoperative ultrasound was used to reconfirm the site of the tumor and to probe the remaining liver for subfoci! The robotic arm was re-installed, and a large circular needle suture was used on both sides of the ischemic line and drawn to both sides to draw a pre-cut line, increase the electrocoagulation power, and start the liver dissection. It was almost bloodless and the intrahepatic ducts were fully exposed, it was beautiful! After 100 minutes of dissection, the entire right half of the liver was removed with really little bleeding, no more than 50 ml. At this point, the robotic arm was removed and the specimen was removed with a disposable specimen bag. The specimen was so large that another 5 cm incision had to be made in the lower abdomen to remove it completely. The incision was closed, the pneumoperitoneum was re-established, the abdominal cavity was cleaned, and a drainage tube was placed to end the procedure. The total time taken was 7 hours and the bleeding was 100 ml. Wonderful! I didn’t even go to eat during the surgery today because I was worried about missing every step, but I was very impressed after watching it, and I also had some insights. 1, the cloth hole is very critical. Generally not too close to the surgical field, each hole should be a little distance between. 2, the surgical steps are similar to the open, try to disconnect the blood flow in and out of the liver! 3, into the mirror hole and and operation hole can be converted at any time, convenient operation as the first principle.