Prof. CHANG-MING HUANG Totally laparoscopic radical total gastrectomy

Yes, perfect. It's very clear.

Perfect. Okay, great.

Okay. I think 10 minutes and your moderator will be arrived to discuss your life surgery. Okay?

Okay. Okay. We are preparing for it.

Okay. Thank you very much.

Thank you.

32 32

OK OK

This ICG that stepped on that

Now in the video

This IC is still very clear.

That's right.

Tianjin, you have to take a photo later.

Give Cao Hui a headset.

Cao Hui, Cao Hui, give him a headset.

Is there any more?

Let's give Cao Hui a headset. Cao Hui can speak English.

He can answer.

Didn't you say you can still use this super-thin knife?

It was supposed to say

the lines are all done, right?

Yes, yes.

It's done.

因为我们有直达的航班啊

就是啊

就是啊

只有没有铁

这个不过北京上海

比较刚刚可以概率我的一个

所以一定

我们到沈阳

津亭就在吉林嘛

那个给他

纱布给他拿出来算了

Hello

没什么出息

Can you hear me?

Professor Wang

有人在叫你

Good morning

Good morning. How are you? Fine? Can you hear me? Professor Lee?

Professor Perry Mason.

Yeah. I'm so glad. I'm so glad.

Long time no see.

Dear Jiaming, finally.

Long time no see.

We'll stay together another time. Beside me, there is Professor Vito D'Andrea. Do you remember him?

Good morning.

Good morning, Professor Vito D'Andrea.

Yeah, I remember D'Andrea.

Yeah, we had two commentators for you this morning.

I'm so glad hearing about you.

Last time we met each other was exactly four years ago.

Do you remember?

Yeah, four years ago.

Two gastrectomists with Professor Palazzini wearing a mask and two joysticks in his hands with a 5G.

It was the first massive teleconsulting.

It was an amazing experience.

But the past is the past, and now we are here today, this morning, I think that in Fuzhou it's in the afternoon, 3 o'clock or more or less, yes?

Yeah, in the afternoon.

Okay.

Dear Jiang Ming, can you show us the story of the patient, please?

The professor policy means we're showing the case reports of this patient?

Yeah.

Yeah, of course.

Can you show us the case reports of your patient?

We have two.

Yeah, I will show you.

How many operations we performed this afternoon?

Today, Professor Huang preparing to perform the total laparoscopy, total gas check to me.

Yeah, yes, I like it so much, as you know.

And then Peter Andrea is beside me.

How are you?

Nice to meet you.

Very well.

Hi, Professor Dondrell.

Nice to see you again.

I cannot see the video of both of you.

Yeah.

Just the voice.

Would you please turn on the video?

No, no, no, no.

I can't see the video.

I just see your face.

I'm really, really glad to see you,

but we need maybe for the pool

just to look at the operation.

Good to see you.

Now, I don't have any images of the laparoscopic procedure.

I see just you.

We see just you.

Just me?

Oh, the operating room has to turn the operating screen out.

At present, he can only see me on the Zoom platform.

Can we start now?

Jiaming, how are you? Fine?

I'm fine, thank you.

Long time no see.

I'm sure, yes, four years ago. And before I forget, I forgot this morning my wife told me don't forget to give you, Professor Wang, my personal greeting. And so I do it.

Yeah.

Okay. Can you show us the case report of the patient, please?

Okay.

Welcome you to visit our city again.

We don't see anything now.

Yeah, can you see the case report, Professor Perez?

No.

No?

No.

Okay, I will turn engineer to...

I don't know what's happening.

Yes, yes, yes.

Engineer, did you not transfer it?

I read that you sent us the sharing of the...

Yeah. And the other surgeons, the other friends, Professor Zhang and the other, all are doing well? Yes.

Yes. This year after COVID-19, I think everything is recovered.

Yeah, yeah, sure. Yes. Maybe in Italy. You know that I retired three years ago, and now I quit my job.

but this year

you're retired?

yes I retired

but I'm very happy

and here this morning

I'm here for you

thank you

I think that

the technician here said to me

that you should

to withdraw your sharing of the video.

It's from you.

You have to cancel,

to delay the sharing of the video.

It's our problem.

Is that a green one, IGG?

Yes, it's a green one.

Let it jump to 50 first.

Let it jump to 50 first.

Up, up.

Yes, that's okay.

That's okay, that's okay, perfect.

等律师,然后给他调到50来。

Okay,退出。

And so, can you show us now the case report of the case report?

这就没那么浓。

Case report.

先调75算了,因为我们等一下一打完就开始做了。

I have the vision of the laparoscopic, the camera now, okay, but...

Yeah, it's the camera, but I can't see you.

You don't see me?

Yeah, I can't see you.

Excuse me, I don't see you.

Anyway, we have the case report, okay?

Oh, yeah, yes.

You don't see me?

Yeah, I don't see you. I can see the case report, but I didn't see you.

Just a moment.

Yes.

Okay.

Okay.

Okay.

Bye-bye.

Hi.

Beat the Andrea in me. Okay. Good morning.

You can start over.

We can start over.

We can start in the report of this case?

Yeah. Yeah, sure.

Yes, it's a male, 62 years old, his BMI is 23.7, and 10 days ago, he had a diagnosis with gastric cancer, and his history was no special, no abdominal surgery.

Yeah, it's a CT scan, but usually we will tell the patient to drink 1,500 ml of water,

but this patient didn't drink, so we can't see the tumor clearly, but we can see maybe

And maybe the serous load is great, it's not invasive, so it may be T1 to M0 to M1, maybe.

And you can see the endoscopy, next one, it's endoscopy, yeah, the tumor is located in the

the body of, in the post-work of the gastric body, yeah, it's, maybe it's earlier gastric

cancer, so Professor Huang will perform the totally gastric, laparoscopic radical gastritomy,

yeah.

And so the lesion is not, is not suface, the cirrhosis, it's in the T1, okay?

Yeah, T1 or T2, I think.

Okay.

Okay.

Okay. Thank you.

Come in. Yes, I'm here.

Okay, nice, nice.

We see very well.

Okay, great.

Okay.

I'm sorry, just for the

pool.

Which is the position of the patient on the table?

Plus ICT. Can you explain better what the ICT is?

Okay, we inject the drug, the ICT drug into...

Usually we inject six positions in the entrance...

How many spots?

have another 3.3 injector. Okay. So this method was easier by the endoscopy injector like G.

Yeah, yeah, sure. Do you remember we performed the day before the injection by endoscopic

You are performing the detachment of the Great Aumentum, okay?

Usually, this is an ultraseason, okay?

Professor Perez, we can't hear you clearly, so would you please a little loudly?

I don't know. Do you hear me now? Is it better now or not?

Yeah, it's better, better. Now it's better.

Nick, I remember very well.

I know you perfectly.

You are really one of the greatest surgeons in the world about gastric surgery.

I know that.

Yeah.

Thank you.

Thank you.

Okay.

Okay.

This is the retrocavital.

The peplum is open now.

Very well.

your dissection is always neat and fast. Yes, I think so. Without bleeding, I know very well.

Excellent. This patient's BMI is not high, but I think he has

just a little abdominal obesity. He has a lot of greater momentum.

Yeah, in Italy it's a little different, as you know, but the BMI is 23, you told me, yeah, okay?

Yeah, 23.7.

Yeah, that's good.

You're proceeding?

The audio is a little higher.

Yes, because they don't feel well.

Yes.

Okay, fine.

very well

ah yes

the same approach

that we have maybe

in Italy is

ultra-season I think this is

really a device extremely useful

and extremely safe

really

I see the Giacobo

hi Giacobo

the best

the best in the media. Okay, this is under the right column. Okay.

And you are finishing the detachment of the great momentum. Yes, very well, very well, very nice.

We can see very well now, the vision is really okay. Can you hear me well? Okay, yes.

Yeah, most of the greater omniscience will be removed.

Yeah. And the position of the person on the table is just in the little trindelium or not?

Yeah, trindelium.

Yeah, the contraction, okay.

Trindelium.

You are near, this is at the bottom we are at the head of the pancreas and now the dissection

is really fine, it's really good, very well.

Do you see any lymph nodes there?

Yeah, sure. And in the particularity is how you use the suction, the sort of aspiration at the same time, yes, but at the same time it's sort of counter-traction, this difference in front of our habit with aspiration, just aspiration.

Usually we will transact the white gas at the point of pain first, because usually it is below the head of the pancreas.

For example, sometimes when I walked some years ago in my center,

For example, this part around the vein, we section the vein using the ultracision without putting the amyloid.

Anyway, this is good, but sometimes we perform just with the ultracision.

All right, okay.

What do you think, Andrea?

This is a nice dissection around the gastric vein.

Yeah, sure.

Really precise.

If the tumor was located in the lower third of the stomach, if the number six lymph node was enlarged, so maybe we will dissect the number 14.

That's enough.

Okay.

It looks like.

Okay.

This is the artery.

Okay.

This is really.

The section is important.

And in this part of the operation, I remember, it's really important to stay not too close

to the duodenum.

Sometimes it's possible to have some lesions about the ultraseason.

In excessive skeletalization, sometimes it's dangerous.

Do you agree or not?

Yeah.

a complete lymphadenectomy

in the station 5-6

normally we have

we should

just clean the camera

be really careful about the

second portion of the duodenum

because this is really fragile

and sometimes maybe

with the ultraseason

you can

put inside some

Great, great, absolutely, nothing, nothing, nothing lost, yeah, okay, and so we start with the gray curvature of the stomach, okay, okay, this is the pancreas, all right.

Yeah, sure. And sometimes, you know, this is just behind the curvature of the pancreas behind 11P. Sometimes it's hidden inside.

Yes, in the pancreas.

Yeah, in the pancreas. Okay. It's perfect.

Yes.

Yes.

Sometimes it's slightly bleeding, as in this case, okay, because you have to push inside the pancreas, not inside, but just really, really close to the pancreas.

Yes, very close.

Sometimes it's just a small bleeding, okay, just perfect.

Because anyway, the 11-11 station is just behind, just behind the pancreas.

I suppose that goes back.

脚距不太对啊。

脚距差一点。

脚距差一点。

In the spring,

脚距不太对啊。

We can see

脚距不太对。

脚距差一点。

Yeah, the splenic vein

may be there.

We are really in the

11th

station.

Can I shift with the vision

of the lymph node station with

the dye

the tail of the

pancreas

along to the

posterior side of the

left side

explain the cat

can you check

the lymph node station

with the

with the

with the ICG

I think ICG

is always too long now

a lot of

fatty tissues

in this patient

there has to be

plenty of cataract behind there

just a little

yes ok

Now, it's one of the most important lymphadenetomy.

That's the splenic artery there, okay?

Yeah, that's it.

It's there, okay.

Okay, and I'm sure you're just too clear with this panic artery, and we are just in front of the 11-B, 11-D, 11-B.

patient.

Yeah, because the section must be meticulous.

Yeah.

Very well.

Just in tight contact with the superior face of the pancreas and the 11P is just behind.

and

we always check with

by fly, with the

fluorescence, this is really

really inside, really good

very well

congratulations, very very well

congratulations really

because it's apparently easy

it's not easy, absolutely

easy in the hands of Professor Wang

section, really clear

really neat

just

The Celiac Tract.

There are two vent in this area.

At the behind is the Celiac Tract.

That's correct.

One

one

one amulet is enough.

So we

do it.

This one is going to break.

Come on.

Hurry up.

Celiac Tract.

Why is there so much?

It's dry.

肝硬化

这个多效果

这个也是效果

这个可能有肝硬化

然后这个静脉太多了

这个静脉

这个在背后

现在没看到

We can see just the scalpel with the section.

In China, lots of experts say that it's Professor Huang's left hand, left hand, and right hand.

Yes, the gastric cartilage there, okay.

It's the right hand of Professor Zheng and the right hand of Professor Huang.

okay yeah let's get to get to you sure the best of Django with the sucker and

the mean with the MLOC okay and now the section okay so today you should it was

all right I feel like it can't hide to go make

check you're approaching the the main area of the storm from behind yeah yeah

Yeah, really close to the right pillar on the left, the left pillar.

Yes, just, okay, just a little bit in there.

Yeah, just close to the left pillar.

Yes.

Yeah, sure.

Yeah, sure. It's really close to the lower portion of the esophagus.

Professor Perez, this year I think ICG used for gastric cancer is more and more popular.

Do the Italy experts perform lymphogastritis with ICG?

yeah sure this is yeah really yes it's a wider is a wide use of the how do you

think about this technique I think this is excellent and because it really safe

really yeah it's more safe and more than even us and there's no you know that we

have the habit from the the day before to to spot the the lesion of women but oh excellent yeah okay

it's really safe and fast much easier these days these days they are good news for uh professor

because the long-term survival results about the ICG

research results have been published in the Natural Communication

and for three years follow-up we found ICG could improve patients overall survival

In our center, Professor Huang performed a lot of clinical trials, especially for the ICG used in gastric cancer.

Yes, we have the first RCT research. The primary result was published in JAMA Surgery. We found that the ICG could have more lymph nodes received.

I like STOS 4K plus ICT. The green light is comfortable during operation.

Absolutely.

It is really useful. ICT can identify where the lymph nodes are and you can finish the retrieval of the lymph nodes.

help to detect the lymph nodes and make the operation

more safe. You know, that's a great demonstration

there. Superficial. Because sometimes, okay

with the technique by laparoscopic approach, but sometimes that could be

really dangerous because you can lose some lymph nodes

inside. And with the ICP technique, that's

much easier. It's safer. It's a complete

The professor found that the president was so expert they can control the situation during

doing an operation to the well.

Yeah.

It's being controlled.

It's being controlled.

When you get to the tongue section,

the other side is broken.

The other side is broken.

Where?

Where I pressed it.

Again. Again.

Don't do it again.

I'll just break it first.

Are you sure that with the new technique,

with the ICT into a pellet,

it's really extraordinary, amazing?

I was just wondering if you have any data or any evidence

that with the ICG, which is great, I can see in this case,

is that with ICG, the number of lymph nodes you retrieve

is higher than the number of lymph nodes you retrieve

with a simple D2 lymphadenectomy.

In other terms, what's the real value of ICG

other than actually looking better?

Is there a number or any evidence?

Yes.

Yes, Dr. Trebala is the surgeon that took over me

me two years ago, and now I'm really happy. Ciao, ciao, Tebala. Ciao, ciao, ciao, ciao.

We have a great tradition about the gastric surgery, and Tebala tried just to continue

in my school.

ICG guide for the lymph nodes dissection.

We have performed the single-centered RCT with results.

We found gastric cancer with ICG may receive more lymph nodes.

The average lymph nodes for each patient we received with ICG is around 50.

And without ICG the average lymph nodes is about 42.

The same thing that we perform the guided lymphadenatomy under fluorescence with robotic approach is the same.

Yes, I think this is a really great, great technique now.

You show us, you showed us today, it's a really beautiful technique.

And more lymph nodes dissected, received with better survival, that was published in last

week.

We have followed up for three years for these RCT patients.

We found patients with ICG for lymph node dissection to have a higher, around 12% higher for overall survival.

Oh, that's absolutely interesting.

Yeah, it's published in Natural Communication last week.

Yeah, that's good. And for example, with robotic approach or with lymphadenatomy by fluorescence, the average removal of the lymph nodes was about 70 lymph nodes. You remember? 70. It's really high.

Yeah, I like to do that.

Okay, yeah, yeah, sure.

That's perfect.

Now you section the duodenum?

Yeah, section the duodenum.

It means white or blue charge?

White.

Yes, white.

We usually perform the blue with the blue charge.

Okay.

I think it is much easier after you section the duodenum.

Yeah, it will be better for this area, the lymph nodes dissection.

Yeah, more easy.

More easy, yeah, easier.

然后去呀,你看这模模糊糊的。

And me too, I always perform before the section of the venon,

after starting with the lymphadenectomy of the restrictions.

蛮劲的呀。

Because I think this is material.

真气嘛。

这不是蛮劲的呀。

这什么?

是蛮劲的呀。

而且Professor Wang in the position on the left of the patient.

那不是。

Yeah, he's still in the left side.

The approach is more just in front of the surgeon.

It's much easier.

Yes.

Yeah, sure.

And the last time that we worked in an attorney,

I changed my habit and the position on the left

of the patient as Jiang Ming.

And always I thought about him because really

this position is more comfortable for the patient

and more safer for the hemodissection

and more safer for the vaginal.

Just in front of you,

all the liver of that,

you have to retrieve.

I think this is a great demonstration

of surgical dissection.

My compliment.

And it's easy.

Now, just for the sake of people

who's watching the operation

on the main hall over there,

just a question. What is your left hand doing at the moment?

You're working with your right hand, which is okay. What about your left

hand? It's performing a contraction of the

because the zynga is

the suction from the second operator.

So the left hand of the operator

The right hand is the ultrasonic, the left hand is

the contract traction. Is the Johan over there? Yeah. At six o'clock. Okay, good.

It's different from our habit. It's completely different. This is why I asked this.

Yeah, sure. But the last year I changed my habit like this,

because really it's more comfortable, much easier for the surgeon.

that performed this kind of lymphadenectomy.

The problem was all my thought is about the portal vein.

Sometimes it's, especially if the BMI is higher

than in this case.

On the left, we see the portal vein

just under the side flow.

Very well.

I totally agree with Amilcare.

the value of a good assistant

is essential

absolutely

it's a really important part

of this

but you need

a practice about this

because at the beginning it's not easy

and when we perform

just in a traditional

use of the

what is used in the right

and the left hand of the suit

it's a

It's a different habit, it's a different way.

Okay, there.

Important thing is the left hand is perfect.

Dhamman, congratulations, perfect.

No lymphoma behind.

No lymphoma inside the abdian.

Okay.

It's true that this patient,

the reason why this patient is really fragile,

that a good D2 lymphadenectomy

has a higher value

than an ACG guided lymphadenectomy

I mean ACG is okay, it can be useful

that Jiang Ming is performing now, today, is extremely, extremely difficult.

It requires a really high skill.

Absolutely, I totally agree.

You can see that it's easier, but absolutely it's not easy.

The message for the young surgeon is that it's easy,

easy. It's beautiful to see, but it's difficult to perform. And so be careful, especially when

you approach the portal vein. Sometimes the damage there could be really, really dangerous

for the patient and for the surgeon at the same time. It's not easy, absolutely. Just to the

right pillar, and so you can approach the lower portion of the esophagus. Okay, beautiful.

I'll ask Professor Hua.

Because it's early gastric cancer.

And this case is, I think it's with a little

bad tissue, you know, betamina.

You know that this is, for example, inside the station 11.

I think this is just deeper there.

good. So Professor Perez, you usually shoot like this way, this method? No, no, no. No? No. You remember. We think that the section with the separate vessel, you know, but anyway, it's good, obviously. I don't remember maybe in more than 300 or 400 gastrotomies. We perform just sometimes, maybe sometimes, but usually we don't

surgeon as his diabetes his practice yeah okay I think there's an extra

safety why not yeah I agree with the table but in our Center you know this

This year, maybe we were finished 1,500 cases for the gas checked.

I know very well.

This is your behavior anyway.

The results are excellent, obviously.

But, dear Jimmy, I think that the same behavior,

you could have the same behavior without this extra safety.

Yeah, no, absolutely.

At the end of the day, it's our experience.

It's the surgeon's experience.

If they feel safe doing that, absolutely welcome.

I think it's something that should be in the

armamentarium of any surgeon. It's there. It's a useful maneuver.

Why not when you need it? I totally agree.

While he's doing these last stitches on the duodenum, just a

consideration. In the past, I had a couple of episodes of

pancreatitis, postoperative pancreatitis,

which I think were due to the use of the suction

section device on the pancreas.

You got any experience about that?

I can answer you.

I don't think there's any

problem about the section.

Probably

could be about

the power that

the monopolar,

especially monopolar device,

so bipolar is more difficult.

Thank you.

You need to

introduce our department to them.

Okay.

It's possible and damage on the brain is from the section.

There's a lot to share.

Very well.

Very amazing.

Our center now is one of the biggest centers for gastric cancer.

And for gastric cancer,

once a year we will have more than 1,300 cases for operation.

The chief is Professor Huang, and he is leading us with some clinical trials, randomized clinical trials, and for example, the ICG.

The RCT is a technique, they have performed the speed RCT with the results published in

the JAMA surgery, the natural communication, the BMC medicine.

Because I always remember that your technique of these three steps of lymphadenectomy is absolutely amazing, absolutely amazing.

In this case, I think that's enough for the standard of T2 lymphadenectomy.

And this year, last year, last year we have published one manuscript in JAMA surgery.

We found the advanced gastric cancer located in the posterior side with T4A patients will have benefit from the number 10 lymph node dissection.

Yeah, but it's true the lymphadenatomy of Chen's station is really, really difficult.

Yeah.

Really.

But for the early gastric cancer, the lymph node, the number 10 lymph node will not have

the survival benefit. The spring preserving number 10 lymph nodes dissection is, I think,

is a difficult technique for the lymph nodes? Absolutely not.

In this case, it's possible to have some pancreatic problem with just a fistula postoperatory

Several years ago, Professor Huang made a method called Huang's three steps for number 10 lymph node dissection.

For this complicated technique, he separated the dissection for three steps.

The first step is like this, in the inferior area of the spleen, we reveal the left gastric

epipoint vessels, and dissect one or two short gastric vessels, and dissect the number four

aspid lymph nodes.

The second step usually will start from the middle of the splenic artery, from the splenic artery to the splenic

And the nanometer for the vessels,

the oscillator and vent is complicated.

Why is it so loud all of a sudden?

Isn't it that loud?

It's just like that.

It's wide.

It's wide.

It's not the same.

Yes.

It's very loose.

It's loose.

Come on, hurry up.

Up there.

Yes, come on, hurry up.

There's a new one.

Come on, come on.

You can't put it in because it's not local.

there's really no need to go much lower down in this case, isn't it?

Yes, this is the standard D2 lymphadenate.

There are no three steps of lymphadenate.

Guangqiu, can you explain it?

and the number 10 lymph nodes is necessary for the D2 lymph node dissection.

But usually, they want to perform the splenic, remove the spleen, but this, yes, I think

more research shows that if the patient can make a splenic preserving the number of lymph node

dissection, the post-operation

complications will be lower and with more safe

operation. I think that the spleen

perception... As long as you're

able to remove the number 10 lymph nodes in case of

cancer of the great curvature, T3, T4, I think if you can

preserve the spleen, it's a great advantage for the patient anyway.

Yeah, I agree with you. But if the advanced officer gets cancer, this year we have five years follow-up with our randomized clinical trial.

out, we found the number 10 hypnose dissection had a better overall survival after five years

of follow-up.

For which kind of cancer, which stage and which location?

Especially for patients with T4A, M+, yeah, M positive.

In those patients, we tend to do a neoadjuvant treatment.

Yes, neoadjuvant treatment. I know in the Western countries, neoadjuvant chemotherapy is

popular. But in the eastern countries, it's not so popular, but this year I think more and more

patients accept this method for advanced gastric cancer. Professor Huang was also a PI for one

for one clinical trial

about the new

chemotherapy

with PD-1

and

drugs

and

PD-1

for more advanced

cancer patients

we have

finished

this research

patients have

higher PCR rate

Major response rate for the chemotherapy with PD-1's group is interesting.

Adjuvant terabine, PD-1, I don't know if it's really useful.

I don't mind.

You can't lift it up.

You can't lift it up.

We have to deal with this.

The hamstring, the spleen, the great omentum.

This is the other difficulty for the number 10 lymph node dissection.

Sometimes the great omentum is hamstring with the spleen or the abdominal wall.

Yeah, the omentum tends to stick where you don't want it.

没有可能是,啊,那里有点好。

沙布给我。

The lymph of the anatomy is almost complete now.

Just a few...

关键要把一下。

关键要把一下。

Years ago, when Professor Huang and Professor Sun go to the attorney for the operation, do you remember? We also used the STOS, the ICG equipment, laparoscopy, but at that time it was, I think it was blue line?

Blue, blue, do you remember blue?

Blue, yeah.

Blue, blue.

Now they are changing, improved equipment.

It was a different technique from there, yes, sure.

Many things have changed.

And now Professor D'Andrea showed me a picture from that time

with you, Professor Wang, and him in Rome and in Terni.

Yes, in Rome, we were stage galleys.

That's a great, that's amazing.

So beautiful.

And a picture in front of the Colosseum.

Four years ago, do you remember?

Yeah, yeah, four years ago.

Yeah, four years ago.

Six.

And the other time, six years ago.

So, two times they went in Italy.

I am absolutely impressed by your technique,

but also absolutely impressed by the technique of the suction device.

That's true.

He's doing 50% of the operation.

Yes.

Ish.

Ish, ish.

So usually, because there is no assistant, it's a second operator.

Yeah, of course. It's making things much easier for the main operator.

Yeah, because of the sections make the area, the dissection, clearly.

Yeah, yeah, absolutely. It's nice and clean.

The different use of the dissection, different dissection and dissection.

Professor Huang is a master.

I think he always make difficult operation easier.

The difference. That's the difference, yeah.

Unbelievable. I can't say that I think this is the greatest surgeon,

gastric surgeon in the world. I know another one now.

Thank you.

No, it is true. It's true.

Him and his team. Absolutely.

I have a translator for Professor Huang.

Yeah, he's the best.

It's made really, made really true.

Okay, that is 11D, the distal part of the splenic artery.

And you never use, as usual, the bipolar coagulation, never, just with the...

We will not use the bipolar.

I knew anyway, that is for the audience, for the insurgents, the personal one doesn't use the monopolar, bipolar coagulation of the section, just with the ultraseason.

oh great

that's great

you have to

complete

the lymphadenectomy

yeah

because

sometimes it's

deeper

deeper

than you think

that's another

trip

on the lymphadenectomy

you know

just arrived

just in front of

the aorta

I like it

so much

during the

elevation

beautiful

that's

really

yeah

11B

lymphadenectomy

that's

Look at this, look at this, the P station is really deeper, deeper than you think.

It's a really great to see, to make me like this.

Congratulations, thanks.

Yes, good, good.

Sometimes the temptation is just to leave there.

Okay, that's the real...

11-B lymphadenectomy. Good.

You know, Dr. Tabula, this is really

12-B, 11-B lymphadenectomy.

That's difficult maneuver.

We tend to do the 11 lymph nodes starting from the celiac trunk and going towards the spleen.

This is a nice technique coming from top to bottom.

It's the technique that we usually perform in interning, as you know.

Yeah, this is the second step, exactly. It's apparently easy, but it's not easy.

Oh, the lymph nodes are deeper and deeper, just to arrive at the level of the adventitio of the aorta.

Nice, very, very nice, Jamin, very nice.

And the traction on, I say this for the young surgeons, the traction on the splenic artery is fundamental, it's really important to perform a complete 11-B lymphadenectomy.

Without this traction, it's not possible to perform the lymphadenectomy.

Okay, so a sort of big hole, yeah, it's beautiful, and a big hole.

APLB procedure for cancer of the body of the pancreas.

So, I'm here.

Good day.

Good day.

Hi, Jack.

Good day.

How are you?

So, there you go.

That's a really meticulous

life of the night to me.

And anyway,

this is just more than,

just a little more than an hour.

And it's really fast.

Oh, thank you.

It's fast.

Thank you, man.

And you see there,

the vein,

the splenic vein.

Very well.

And I think that

you almost finished

this lymph of the night

to me now.

It's at the end.

All right.

Okay.

And I really think that maybe in obese patients,

this technique is much easier by laparoscopic approach

than an open approach.

It's much easier anyway.

Because if you have a patient who is 35 and 40,

sometimes we have a needle in Europe,

to perform a lymphadenectomy, this is really complicated.

skill in this

I think I agree with you

I think that my robotic approach this time

is part of

the operation

but anyway it's not

the case of

Professor Wang

it doesn't need any robot

before

you know how deep we are

how deep you are

exactly

Exactly.

Exactly.

Really, really deep.

Yes.

And the manoeuvre with the TPAP forceps, this is what I think is maybe the cause for some

pancreatitis.

Rare, but awful.

I'm not sure.

I have no evidence to support my idea.

Yes, yes.

Feeling.

Anyway, it's true.

Dr. Lin, you mentioned 50 lymph nodes, but in my opinion, there are much more.

Average, yeah. Average patients with the ICG group have 50

the liver nodes received. Come on, in this case, it will be at least 80. I don't know 80, but anyway, yes. Maybe you'll send a notice to us, Alfred.

from you said really complete absolutely yeah almost finished yeah yes almost finishes complete

do you do you routinely remove the lymph node 110 and 111 in cancer of the upper third of the

stomach and actually we we didn't separate the low one one one or one one zero stations by the way

uh they removed the lymph fatty tissue around the asperger in the lower part of the aspect

I think that the section of the short gastric vessels is much easier from behind, like this situation,

different from the approach of the lateral medium. It's much easier now.

Because from behind the stomach, you are just in front of the gastric vessels.

Totally, totally agree. Even if, I'm not sure if a young surgeon could be confident to approach

the upper shorgastic vessels from below. But this is just a feeling, but evidently

it's much easier. Because especially if the patient is an obese patient, sometimes the

The lesion on the spleen is really easy.

In this case, just behind the stomach, you adjust all the control, the control of all area.

And so the injuries on the spleen is really rare or almost impossible.

On the other side, starting from the lateral to medium, along the great corpus,

sometimes you can have some lesion on the spleen.

Yes, because you pull on the spleen in that case.

Yes, sure.

It's always in its natural side without any tension.

This is a really great message for the young surgeon.

This is a really preferred approach on the gastric vessels, if possible.

When you can, the preferred approach is really just below the stomach.

Finished.

Okay.

You know, this is another lymph node there.

With ICD.

It's a very advanced lymph node.

It's almost like a liver.

This is a very difficult lymph node.

And we have all the esophagus really free.

So, Paul, you're very honest.

Very honest.

Yeah.

Thank you.

Can you translate to us, please?

Yeah, Professor Wang will show you the Hispanic trunk and the Hispanic hide area for us.

嗯,在这里出血了。

摩洛克准备。

摩洛克呢?

Yes, but it's the most...

要得上了。

Sometimes,

it's a little vessel

can be a problem upon your post-operative time.

这个还有一个出血。

大的没有。

我是说大的出血是没有。

这个最大了,压住了。

那个凹,我吸不到。

This case is a difficult case for number 10 lymph node dissection.

You have a lot of different fatty tissues, and the great ommeter is helped with the sphincter.

That's beautiful, really.

That's beautiful, really?

And the

10 ring polonatum and the 11 ring polonatum

at the same time.

10 ring polonatum is no

TG, absolutely.

And the Sputnik

artery

is special.

Not a stain.

No breathing.

Yeah, but the professor performed a great surgery.

Yeah.

Yeah, we can see that.

Yes, beautiful, really beautiful.

Great congratulations by me and Professor Vito D'Andrea.

Yes, really beautiful to see this operation.

Thank you.

For the young surgeon in the pool.

It's really rare, really rare to look at lymphocytes as wide and like this.

Congratulations, beautiful, beautiful, really

Congratulations, Professor Changbing Wang

Professor, Professor Vito D'Andrea

likes to send some congratulations

to Professor Wang, please

Thank you

beautiful really okay it's it's built for operations uh professors in italy and all over

the world professor quans have performed on the total gas anatomy with d2 plus the number 10

lymph nodes dissectioned and because it's two hours after opposition so and professor one will

make a assistant a small incision to assist the reconstruction for the uh digestive yeah

anastomosis yeah so today i think the life of our life surgery will be finished

and thank you thank you the experts in italy and thank you professor one professor

assistant with

a great operation

and excellent, I think

it's excellent

lymph nodes dissection

for all over the world.

We agree completely.

Great operation. Thank you very much.

I totally agree with you

and a great hug to you,

to Professor Wang and all

of you, and this

has been a really beautiful

demonstration. Thank you so much

from Professor Vito D'Andrea

and me

you are all the best

remember you are all the best

thank you very much

thank you very much

bye bye