In order to learn and learn from foreign advanced medical system and technology, through cooperation and exchange with German medical personnel and medical institutions, and to build a platform for German-Chinese medical cooperation, I had the honor to go to Germany for a three-month study and exchange from June 7 to August 29, 2012, funded by Jiangsu Provincial Department of Health, Jiangsu Provincial Bureau of Foreign Experts and German-Chinese Science and Technology Exchange Foundation. I treasure this valuable opportunity, and during the three months of study in German hospitals, I have broadened my horizons and expanded my thinking, and I feel that I have benefited a lot and gained a lot. During my stay in Germany, I had the opportunity to study and exchange in three university hospitals under Professors Waldemar Uhl, Andreas Paul and Matthias Birth, where I studied professional knowledge and surgical operations in hepatic surgery and biliary-pancreatic surgery. The main areas of study were as follows: (1) perioperative management and operation of liver surgery, especially liver transplantation and partial hepatectomy; (2) minimally invasive general surgery, especially extrahepatic minimally invasive surgery; (3) biliary and pancreatic surgery. The three months of study and exchange in Germany are summarized as follows: I. Overview of the three hospitals The Ruhr University Hospital St. Josef in Germany is located in the Ruhr district city of western Germany, Bochum is located in the center of the Ruhr district of Germany’s heavy industrial area, in the hills between the Ruhr River and the Emsch River. The Ruhr River winds its way through the beautiful landscape. The University of Ruhr Bochum (ruhr uni Bochum), founded in the 1960s, has a strong focus on the liberal arts and natural sciences, with approximately 36,000 students and 400 professors. St. Josef Hospital has 653 beds, of which about 100 are in general surgery, which is the mainstay of the hospital. Professor Uhl, who has worked and studied in Ulm and Heidelberg, is a well-known biliary and pancreatic surgeon in Germany, and he was very friendly and welcoming. Prof. Uhl specializes in biliopancreatic surgery, especially pancreatic surgery, with about 300 pancreatic surgeries per year, and is the third largest pancreatic center in Germany. Professor Uhl told me that he had performed more than 100 liver transplants in Heidelberg, but St. Josef Hospital was not qualified to perform liver transplants, so he was not able to perform liver transplants and referred me to the nearby Essen University Hospital to study liver transplantation and liver surgery. Essen is close to Bochum, which is less than 10 minutes away by train. Essen is one of the largest cities in the Ruhr region, with a population of about 620,000, and the sixth largest city in Germany. In the 19th century, the Essen Iron and Steel Company developed and quickly became the largest industrial city in the Ruhr, and with the development of coal and iron resources it emerged as the industrial center of the Ruhr. It was the birthplace of the Krupp family, the pioneers of the German steel industry. There are 18 of Germany’s top 100 companies in the entire Ruhr, and 10 of them have their headquarters in Essen. Essen is also one of the most developed centers of higher education, technical and vocational education in Europe. Six of the 100 most modern hospitals in Europe are located in Essen, one of which is ranked number one in Europe. the University Hospital of Essen, an affiliate of the University of Duisburg-Essen, is one of the largest general hospitals in Germany with 1,322 beds and over 5,500 employees. It is renowned in Europe and around the world for its oncology care, organ transplantation and cardiology. The former head of the Department of General Surgery and Organ Transplantation was the internationally renowned liver surgeon Christoph Broelsch, who performed the first living liver transplant in Germany in 1989 and whose book “Atlas of Liver Surgery” is a must-read classic for introductory liver surgeons. The current head of the department is Prof. Andreas Paul, who is usually unsmiling and silent, but in fact is a very enthusiastic person, answering questions without fail, typically cold on the outside and hot on the inside, or what some call a “hot water bottle” German. Professor Paul was often dressed in a surgical gown by the time of the morning meeting, and it was obvious that he had done an overnight transplant. He is a very hard working and dedicated professor of transplantation surgery, who is basically on call for complex surgeries with Oberarzte (the lead surgeon), and who travels between different operating tables. Hanse Hospital is located in Stralsund, the only private general hospital in Stralsund, which is one of the hospitals of the world-renowned pharmaceutical company Frisenus-Kabi Group. The hospital is located in a beautiful environment and can be called a garden hospital. Professor Birth is a tall, dark-skinned man with a permanent smile on his lips. The hospital has a good reputation in the surrounding areas for this reason. The layout and facilities of the operating rooms in the three hospitals are basically the same. Each operating room is equipped with an independent anesthesia preparation room, an independent hand-washing and disinfection room, a patient exit and a storage room. The separate anesthesia preparation rooms are equipped with anesthesia machines to start anesthesia for the next patient when the previous surgery is nearing the end, reducing the waiting time for anesthesia between surgeries and making the connection between surgeries tighter. Each operating room is equipped with a computer and digital imaging system, and all patient history information, including imaging from outside hospitals, pathology, medication and treatment history can be displayed on the screen. The operating room computer has a surgical display system, which is our most concerned and most used, so that we can see which room is open for what surgery, and also understand the progress of the surgery at a glance, which is very practical. Unfortunately, the information and surgical information displayed on the computer are in German, but the surgical computer can be translated into English by going to google translate. Surgical sutures are basically eliminated from animal-derived mousse sutures and replaced by various sizes of Prolene, PDS, VICRLY and laparoscopic non-degradable or degradable synthetic sutures. The surgical beds in German hospitals are all detachable beds, with special machines for transit out of the operating room, eliminating the need for manual lifting, saving labor and ensuring safety. Every surgical patient, including hernia surgery patients, wears elastic stockings and covers with thermal blankets. There is a sterile thermostatic heater next to the operating table, and the intraoperative rinsing fluid is heated to body temperature, reflecting human-centeredness and patient-centeredness everywhere. Various sutures in the operating room My study schedule in the general surgery department of the three hospitals was: 7:30 am sharp to attend the morning shift, followed by ward check-ups, and around 8:00 am to enter the operating room to start surgery, mainly for various liver surgeries including liver transplantation (living liver transplantation, donor liver transplantation); partial hepatectomy (right hemicolectomy, expanded right hemicolectomy, left hemicolectomy) and hilar Bile duct cancer radical surgery; laparoscopic surgery of the liver and pancreatic surgery, especially Whipple surgery. The surgical approach of liver transplantation is similar to that in China, and the vein reconstruction of liver transplantation is mainly done in a modified backpack liver transplantation style, where the surgeon in charge of the entire transplantation wears a headlamp to increase the visibility of the operation and uses a head-mounted magnifying glass to improve the success rate of small duct anastomosis. Professor Uhl is a skilled pancreatic surgeon with clear thinking and familiar with anatomy, so it is a pleasure to perform Whipple surgery with Professor Uhl, who likes to apply bipolar electrocoagulation and LigSure for the Whipple procedure, there is almost no intraoperative bleeding and the procedure is extremely fast. The pancreatic-intestinal anastomosis was performed with a traditional pancreatic duct-jejunum mucosal anastomosis, and all surgeons were programmed and patterned in the anastomotic steps to reduce the occurrence of complications. During the study period in Germany, we visited more than 40 surgeries and participated in more than 40 surgeries of various types, including 25 with one assistant, which were well received by our medical colleagues in German hospitals. Every day at 3 o’clock in the afternoon, there is a departmental summary meeting, in which the surgeon or assistant returns the operation and the presiding physician comments on it, and all other doctors can participate in the discussion. After discussing the day’s surgery, the next day’s surgical chart is discussed, and the bedside physicians report the chart individually. Every week, there is a joint reading meeting between clinicians and radiologists. Germany is a highly developed modern industrial country with the highest economic power in Europe and the third strongest economy in the world after the United States and Japan and the second largest trading country after the United States. Germany is also the birthplace of modern Western medicine, and Germany represents a high level of European medicine, and in some fields it is even at the forefront of international medicine. During my study in Germany, I felt the coexistence of Germany’s long history and modern civilization, the coexistence of brilliant art and developed science, the rigorous and realistic working style of German doctors, the meticulous working attitude and the conscientious and dedicated working spirit all made me deeply impressed. During our stay in Germany, we were impressed by the German people’s idea of equality, consciousness, discipline and pride of spirit, which was used by the Germans in World War II to conquer nearly all of Europe. The “equality before the law” has invariably crept into the pores of every person in the German nation. A few years ago, one of the most authoritative and internationally renowned professors in the field of liver surgery in Germany broke the law by receiving red packets from patients. The Germans believe in God, and they believe that every move they make is in the eyes of God. German train stations are completely different from those in China, there are no waiting rooms, no ticket gates, and the few ticket checks I encountered showed that everyone bought a ticket to get on the train, all based on their own consciousness, but once found that the penalty for fare evasion is extremely severe, and there is a bad credit record, affecting work and life in Germany. In Germany, it is a habit to obey traffic rules and everyone follows them. Pedestrians have priority in traffic, and cars always give way to pedestrians. For example, when I first arrived in Germany, I stood on the side of the road and waited for a car to pass before I crossed the street, as is customary in Germany. I was surprised when the car stopped and the driver waved for me to pass first, which was very flattering. I later learned that traffic laws require drivers to wait for pedestrians to cross before they can pass. In Germany, you can see many wild rabbits, squirrels and other animals around the city, and people and nature are in high harmony. In front of every supermarket, there is a place selling flowers, seeds and fertilizers, and every household in Germany has the habit of planting flowers and plants. Germany is the first country in the world to establish a social security system, and is the birthplace of the modern health insurance system. Germany has a compulsory health insurance system based on social health insurance and supplemented by commercial insurance, so that more than 99.8% of German citizens enjoy medical coverage. Therefore, no matter what the illness is, no matter how much money is used, all the bills are settled by the insurance company, and the patients are not financially burdened and do not become poor due to illness. In the short three months in Germany, we may have seen many appearances, but I was impressed by the sound medical insurance system, the comfortable hospital environment, the cordial doctor-patient relationship, the excellent instruments and equipment, and the advanced medical philosophy. Looking back at China, we have a huge gap in terms of philosophy, investment and medical system. I believe that in the near future, with the further development of China’s economic civilization and the unremitting efforts of several generations, China’s medical standard can enjoy a high reputation in the international arena. Once again, I would like to thank the Health Department of Jiangsu Province, the Bureau of Foreign Experts of Jiangsu Province, the German-Chinese Foundation for Science and Technology Exchange, the hospital and the department for giving me this opportunity!