C. M. Huang Totaly laparoscopic gastrectomy

Good morning.

Okay, Professor Parisi, I'm Dr. Lu from Changming Huang's team.

Now I want to introduce the patient's information.

Okay.

I think I'm going to have to call someone.

Look over there.

Look over there.

Hello, I'm Zhang Min.

OK.

You are doing very well. Thank you so much

for joining us and

accepting our invitation.

Can you show us the patient

in the case of this afternoon

that you are

appropriate?

Can you see the information?

Yes, I can

I can read the case information.

Okay, okay.

Can you go on?

Okay, I will introduce the case operation for you.

Dear Professor Parisi, dear Professor Changming Huang,

very happy to attend the 32nd Digestive System Surgery Conference.

Now I will give you information for live surgery of Changming Huang's team.

Thank you so much. It's a great pleasure to us to stay with you. And so I now see that

this is a female patient, 42 years old, okay? Yes, yes, this is a female patient, 42 years old,

BMI 21, and the chief complaint is mild epigastric pain lasting about a half of a year,

and the physical examination was no special. The tumor markers including CA or CA-99 is normal

and the preoperative albumin or hemoglobin also novel but in the endoscope examination we found a

two centimeter ulcer in the anterior body stem and the physiology confirmed it was endocarcinoma.

carcinoma. So from the CT scan we find the gastric wall is sinking and considered as a malignant

tumor. This is a CT scan of the patient and this is an endoscope. We can see the ulcer was found

in the body of the stomach. So today we plan to this is a diagnosis gastric cancer and the

preoperative staging for about T3, N1, M0. So today we plan to do the

total gastrectomy. That's all. Professor, may I have your clarity?

I think that's the same indication that we have in our center, because with N1, T3 is a good indication for

a total aeroscopic

without any

neoadjuvant therapy.

You know that in Italy now

we perform sometimes

in well

specified cases

the neoadjuvant therapy.

In this case I think this is just

an upfront surgery.

It's a really good choice.

And so

the lesion is

really easy

to identify

Okay. Can you show the disposition of the troglodytes on the table and the surgeons on the operating room?

Okay.

Jianmin, I'm sorry. Can you show us before just starting with your operation? What are you doing now? I need a needle inside the gastric wall.

Yes, today maybe we are doing an ICG guided laparoscopic surgery.

Now we are injecting the ICG in the sub-cerosal.

Okay, and so you are injecting the dye in the...

Through the gastric wall, just during the operation, yes?

Yes.

Just to trace the pathway of lymph node station.

and how many injections you perform inside the Gattic wall

because I see that you perform several injections in different sites

the giant in the Gattic wall

for example in Great Corbatore

We inject the six points of the stomach ICG was injected.

Three points was the great curvature, and the other third, the laser curvature.

How many millimeters you inject inside the gutting wall?

Yeah, 1.5 milliliters.

Okay, thank you.

The same as us.

And now we can

get to the

section. Can you show exactly

the position of the

first surgeon,

the health surgeon,

and the surgeon

who keeps

the camera? Can you show the position?

The surgeon is between the legs

of the patient. Okay, I can

self or another help surgeon. Fraction of the column now with Joanne is performed by yourself,

your left hand is keeping the column or the odiomentum. It's really, as always,

as usual, it's an absolutely perfect dictation, very well, very nice, and anyway the vision

that we have now is perfect. It's a really high quality vision. It's perfect, really.

And so you are mobilizing all the great cobalture and gas-to-deploy detachment just to arrive

within a record of the deployed cavity. Okay. The same approach that we perform usually

with the laboroscopic approach. The first step is the detachment of quality deployed

Yes, the other two is from assistance to catch the momentum.

Perfect. Okay. That was really, really fast.

Really fast. As always, as usual,

Professor Wang is really fast in his preparation,

and you have almost finished the detachment of the colopiploid detachment

just to gain the radial cavity equipment.

and usually you perform always this detection with the alpha cesium, for example the current

that you know the eating current is bipolar, monopolar or alpha cesium, usually you perform

always with alpha cesium, the dissection with the alpha cesium. Okay, I think that you are

gaining now the approaches about the the diodenum it's really really near

very well very well ah okay this is attachment with the anterior surface of the pancreas

now we are mobilizing really the gastric anthem just the first portion of the

Yes, number 6 is the first stage of lymph nodes we want to digest.

That's really important just to identify the groove, this groove for the identification of the number 6.

And now we begin to see the dye, the ingestion in green here.

Here, what do you think about performing, for example, the injection of the dye, the angiosaline green, the day before intragastric with an endoscope approach?

Do you think this is a great difference between the two approaches or not?

Because now you are injecting the dye just directly during the operation time.

Sometimes it is possible to inject the dye before the operation by a gastroscopic approach.

Okay, you are really identifying just the lymphadenectomy for number 6.

You are just moving fast inside this groove.

And so this is the confluence of the gas-replugged vessel and the confluence with HCIIC-Valuel.

Okay, thank you. You are really, really, really close to the gas-replugged vessel and so you can perform the lymphadenectomy on station 6.

your dissection is really precise, really, really, really good. We see very well, thank you, without any drop of blood.

Okay, she's really, absolutely dry. The surgery field is really dry, without any bleeding. Congratulations.

Thank you.

Very, very well, thank you.

For example, in this case you perform this vein with an amulet, what do you think, for

example, you can use the anthracisium just to section this vein, is it enough to you

or not?

You always put the amulet in the gastro-epiphyloid vessels.

Who's keeping the section?

The first surgeon or the second surgeon?

The assistant, assistant.

Assistant, okay.

This is a really, really good cooperation between the assistant and the surgeon, okay.

Today's assistant is Professor Chaohui Zheng.

She is also a very famous young surgeon in China.

Okay, thank you.

Good afternoon to you.

Now we are exposing the right gastroepipartic artery.

Yes.

Very carefully.

So for the identification of the gastro artery, you approach on the anterior or posterior

or both approaches.

And so you usually put down two analogs on the below just one analog above, okay?

Yes, yes.

Perfect.

Really actively this section is perfect.

Perfect. So you are certain that all the lymphatic anatomy is absolutely complete?

Yes, like this.

Very nice. I see very well now.

Okay.

Look at this side. This is the reflection.

Apparently the lymphatic anatomy is absolutely complete.

And now...

You sectioned the Jordanian wall narrow on the upper.

And so you're starting now with the lymphadenectomy of the psoriasis station without sectioning the Jordanian.

Yes, without.

Yes, this is a new approach. You prepare in a way just perform the supra-mysocolic lymphadenectomy before dissectioning the duodenal wall, right?

After we dissection number 7 and number 9, we cut off the duodenal.

Okay, this is the gastric vein.

Yes, this is the left gastric vein.

That's the material surface of the practice, okay?

And you section the gastric vein with the amylose or between amylose or with the alpha-cysteine?

Yeah, with amylose.

How about your centers, Professor?

Now I see that you are between the legs of the patient, you are approaching now the 11P,

and the superior board of the planic vein.

I see that the suction is used just as a sucker, but at the same time just to lift the section of the tissue.

That's a good indication for the suction.

Sometimes it is not so easy to perform a skeletal section with a planing leg like this.

I think that we need a great skill to perform this scalatization.

Really beautiful.

And you take out all that.

Ah, yeah.

This is another just a little link there.

That's a really good navigation.

A little bit of navigation with the Angel7 Green.

That's nice.

And it's a really good lymphadenectomy, I think, as said by Professor Parisi.

And particularly we use our understanding that in our center we perform usually the day before surgery.

But I can see that it's a really good choice to inject the dye, so I think that we can

start to use ourselves this option.

Anyway this is more comfortable for the patient, just avoiding the gastroscopy the day before

But we can see that the technology is working to see the operating field of the drive.

So it's only there with the technology.

Perfect.

This is a perfect way to follow.

Yes, this is the gastric cartilage.

The sections are really perfect.

It's not so easy to perform by a laparoscopic approach,

but anyway, this is a perfect demonstration

that you can use the laparoscopic approach in modeling.

You know in our center, we perform the lymphadenectomy by robotic approach, as said by Iago, but in this case, the laparoscopic approach is absolutely perfect.

Our approach is hybrid, laparoscopic and robotic.

再来,太佳给我。

the lymphadenectomy, and it will be in 10 stations or not. I don't think so. That's in 11B and 11S.

following the green angiosinine as navigation, lymphadenectomy. Very, very nice this

This picture. Congratulations. We see very, very well.

Just around the Greenland Yosemite as a marker. Very well, John-Ming.

Let's take a picture.

Turn around.

I see that the cleaning of the camera is really great.

You have something particular about the camera

but it needs experience.

Sometimes we approach the right gastric artery

behind the posterior wall of the stomach

or sometimes just with an anterior approach.

It depends on the BMI of the patient

because as you know in Italy,

especially in our religion in Umbria,

the people like to eat a lot

and so the BMI is sometimes really high.

It is not always easy to perform an approach like Steve's one of this format.

It is surprising to me just a note of technique, the use of the suction as a sucker at the same time as for the dissection of the fissure.

That's a really, really important note, especially for the young surgeons, that is really, really useful.

At the same time, you can keep clear the field, the surgical field, and at the same time, you use the chakra as a counter-attraction.

But it needs a really great skill from the head surgeon.

That's the gastric artery, okay? The right gastric artery.

And below this is the dendritium lacque.

Perfect. Both are designed in two different ways.

This is also a medium for young surgeons

that can be anaphylactic.

Sometimes your position is really...

the heat is really high.

呀,那个打开。

哦,对啊,恭喜,完美。

塞口一下呢,塞口一下。

The section now is perfect.

You have all the first portion of the demon world free.

Ah, yes, you change the image.

好。

哦,没有带了。

等一下,广告,这个不行。

来,断。

非常好。

Lin, are you there?

and in these 2-3 years we always use this circuit and we think that's really useful

for just reducing the bleeding and at the same time the crystallization of the edema.

Do you think this is good in an amylose because you know that there is some actually in the left lobe of the liver or not, the right filler, and you always perform this approach after the lymphadenectomy, just after the lymphadenectomy.

So, for example, in our center, we perform the installation of the esophagus at the starting

of the operation.

That's the pillar, and so I think that you can put a slide around the esophagus.

And so now you can complete your lymphadenatomy just through the

the section 9 and just to perform through the esophagus.

I think that you are near the portal vein here.

because your lymphadenectomy is perfect, precise, and really, really fast.

Now we can see the portal vein, and we cut the lymph nodes as a root.

So we think ICG-guided lymphadenectomy is very useful, especially for young surgeons.

We can see the lymph nodes more exactly.

below. We don't put any amulet in this case, in this space of lymphadenectomy. That could be very, very useful. What do you think?

Absolutely, yes. And we use a lot the harmonic case. We think it's really comfortable in the dissection.

but sometimes maybe we can do more MROC.

And it's safer.

Yes, it's safer, yes.

The tendency using more XCAP.

That's unbelievable.

You have a small, really extremely large,

broad length of the night.

That's a great opportunity,

especially for the young scientists,

to see a vehicle like this.

So you can make this all really clear.

So the dissection, the endosyndrome, we can see all the lymphatic stations.

So it's really important for your surgeon.

Don't look at this side. Don't look at this side.

Circle it. Circle it.

Okay, I'll do this. Circle it.

a lymphoma that is maybe is the channel lymphatic channel what do you think i mean i don't think

now you finish your approach on the great pulpit of the stomach right and detachment from the

In our experience, Yagbo said that it is really, really interesting the truth.

In Italy, for example, this tip is, for us, sometimes it is really demanding.

Because, exactly, we need to be in mind of the patient.

Sometimes it is not easy to identify exactly the right plane to reach the planet.

And sometimes it is difficult.

In this case, it's perfect.

This is 21.

Sometimes with simple neuro-experience,

especially if the patient is really fat,

there's the possibility to open the mesocollum,

the cluster's mesocollum.

Sometimes it's not easy to find exactly the right plane.

But now it's perfect.

And you perform a lymphadenectomy of 10 stages.

We're going to do a number 10 lymphadenectomy.

You perform the three steps of lymphadenectomy, that's a great opportunity.

I think that you perform an extraordinary approach, because the three steps of lymphadenectomy,

I say that to all the young surgeons and the older surgeons that are listening now,

is the approach just to propose the secretion by Professor Wang.

and one of the most brilliant, impressive lymphadenectomy.

In this case, I think that you change your position

and then you put yourself on the side, the left side of the patient.

That's really beautiful, as you see.

That's really extraordinary lymphadenectomy.

Anyway, it's really weird to see.

The ICG guided surgery, we can see the infected vessels very clearly, right?

So maybe for the cancer located in the stomach body, the number 10 lymph nodes are likely

to metastasis.

So for some of the patients, we should do the number 10 lymph node dissection, although

it may be very difficult.

Well, the patient takes off the lymph node metastasis in the stage 10, in your experience,

in this case, for example.

Yes.

I think that's one of the most demanding and difficult lymphadenectomy

Because the spectrum turn is a really way to perform

So we are not a document used to perform

Anyway, it's really required a really high skill from the surgeon

And from the surgeon

I think so

All the team together

It's at the back

All the team together, that's really difficult

I'll go over there and take a look.

It seems really easy, but in reality it's really difficult.

Because your ability to render something easy is really really difficult.

Thank you so much. Thank you very much.

Give me the next one.

With breathing control, perfect.

Beautiful.

This is a left gastro-epiphytic vein.

Is it better now?

Hello, can you hear me?

Yeah, much better, much better.

Okay, thank you.

I put on my earphones now.

And we were saying that it's an extraordinary demonstration of one of the most demanding and difficult lymphadenectomy.

Oh, yes, beautiful.

You need the green endocyanin, perfect.

You are investing exactly all the lymph

inoculation, and this is a really great

gift that you have for us

today, Professor Wang Jianmin. That's a really great demonstration,

really impressive, how to exactly perform

and the name is the three steps lymphadenectomy as you perform the first

in the world and so this is an extraordinary opportunity for all the

surgeons to see now today how to perform a lymphadenectomy station turn and

block with the other stations. Really excellent demonstration, really

really impressive. Thank you, really.

Thank you, Professor Parisi.

We also very thank you for your support

to our team.

That's the truth.

It was a great occasion.

Really, really.

And the image is really clear, beautiful.

What do you think, Yagbo?

It's really impressive.

You see, yeah.

The truth that we are just a little

accustomed to this little anatomy

because it's not the first time

that I see

Professor Wang performing

and 10 lymphadenatomy

but every time

it's really

really nice

it's unbelievable

the right plane between the spleen

and the lymph

lymphatic station

the right plane every time

without any

any indecision

and it's really fast

at the same time

the open in all during all the your operation just three times no more

is a perfect and so now imagine that you can join the 11 11 s 11 just to perform

the vesting of unblock of the lymph nodes yeah okay and so from the loose

planning you can join the the other point yes with explaining yeah yeah yeah

Yeah, very well, yeah, show us very well this passage, because it's extremely, extremely interesting.

This is really the three steps of lymphadenectomy, laterally, posteriorly, and atheromedially.

It's a really meticulous dissection of the lymph node station.

What do you think, young boy, it's really, we keep silent, huh?

I think in this case, the silence is the best command for your operation.

traction the joan and not more the dissection, you change, okay, there is no drops of, yes

Yes, absolutely, without any minimum bleeding.

It's amazing.

but I think that if you want to try, you should be really wise.

It's absolutely so easy.

It's extraordinary, extraordinary lymphadenitomy, really.

I'm really impressed.

In the past I saw that you changed your position, sometimes you put yourself on the left side

of the patient, this time you stay always between the legs of the patient, that's correct?

When we do number 10, Infernal Dianectomy, we stand with two legs, patient with two legs.

I think that

you should go there for some

months just to learn this technique

because it's

absolutely

worth it

because it's not possible

a unique way just to

perform is just to stay with

them some months, I think so

what do you think Jamin?

do you accept the visit of Jacopo

in your center?

I think it's sufficient

they are very high volume

and they perform

I think

7 gastrectomy

maybe per week

yeah sure

more than 1000 gastrectomy per year

and the first center

in the world

for the huge number

huge number

anyway

Anyway, if Jamin agrees, you can go there in two or three weeks in a fuzhou just to learn this technique, because it's not possible to perform this technique now in Italy. It's really, really difficult.

If I remember very well, the same technique you performed two years ago in Terni, when you stayed here in Terni, do you remember, Jamin, when you performed with the 5G, he has the same lymphadenectomy, do you remember?

Yeah, yeah, yes.

I have great memory.

memory ah yes for the same to me it's um unforgettable unforgettable but this time

is really ah yes beautiful jamin thank you so much you are really master of surgery

yes yeah yeah absolutely yes i imagine that giorgio parazzini

Anyway, it's true that after this operation, it's really, really hard to perform another

live surgery, a biogasic surgery.

Okay.

Yeah.

Okay.

Okay, just a right of the posterior wall of the knee of the esophagus.

For example, our behavior is just to put a slide around the esophagus

at the beginning of the operation,

and just to have a good traction at the end of the operation.

In this case, you don't need to put a slide before, but our behavior is just a little different, yes.

Okay, this is the left pillar of the diaphragm, and you can, yes.

The diaphragm of this pillar is absolutely clear, yes, yes, thank you, very well.

It's really interesting, using the suctioning and the dissecting.

Very nice.

All right.

I think the esophagus now is well prepared.

You can section the vagus nerve.

And anyway, you can see very, very well.

well. Sometimes our vision

is from the right side

through the left

side. In this case, it's

just below, on the

posterior wall.

mediastinum, yeah, just to

keep free

the esophagus. It's really

well-prepared, very well,

just on the right side.

That's a really good lesson, good

teaching for the young surgeons now.

And Professor Palazzini

and we'll be really grateful to you.

Oh, really beautiful.

Okay.

This is really a vagus nerve?

Can you hear me, Jamin?

Yeah.

Yeah, the vagus nerve, yeah.

Okay, thank you.

But next time, if God wills,

another time in Terni with me,

I put today a reservation for your presence in Italy.

yes professor hi okay how are you yes i recognize your voice lena okay i'm so glad he oh how are

you fine i see you now thank you because i'm so glad to see you again i'm so glad i'm so

glad seeing you again good afternoon yeah good afternoon you are good morning thank you yes

Yes, here in Italy now it's 9.30.

Yes, this is for the traction of the left lobe.

Yes.

Yes, that's good.

Yes, good traction.

Just sparing another four chips inside the abdomen.

Yes, that's good.

Really good.

sir okay that's a good traction for the left lobe like this is a perfect and your vision side the

abdomen absolutely clear and we can see very well and it's a really extremely amazing extremely

beautiful demonstration this this afternoon it's a great operation really thank you

I see Professor Palazzini on the other side of the screen, and I think that Professor Palazzini will be really grateful to Professor Wang and you and his team, because that's really an extraordinary demonstration of three steps lymphadenectomy and total gastrectomy by laparoscopic approach.

It's one of the most amazing, really impressive surgery.

Really nice.

Okay, Professor Perez, thank you for your comments.

I will translate for Professor Huang because I think he's busy.

谢谢教授,也非常感谢您奉献的这样的一台精彩的手术。

Thank you, thank you.

Thank you to you.

You are really master of surgery.

Jiang Ming, you are the best surgeon in the world.

It's not possible to compete with you, it's impossible.

Your team is wonderful.

Thank you, your commenter.

That's a great pleasure for me

Great teacher

And Jacopo wants to visit your center

Just to learn these three steps

And Dr. Professor Wang

Translate, Professor Wang.

Okay.

Professor Wang, Professor Pellet said he would like to send this jacobo to our center to thank us for our future.

Welcome, welcome.

And at the same time, me too.

I wish to visit you again after the COVID time, obviously.

Oh, yeah, a good remembering of the time spent with you in Fuzhou, yes, lovely, really nice.

And now you put an nasogastric tube inside just to perform the esophagogegenal anastomosis.

No, no, we have removed the gastric tube.

Okay, anyway, it will be a lateral-lateral anastomosis through a stabler, okay?

Yes, we used the overlapped method, but Professor Huang modified this method because we called it later cut esophageal jejunal anastomies.

So we were not transacting the jejunal first, we first made an anastomosis.

I will try the technique used by Professor Wang, maybe in the next future, because I think this will move faster, and the reconstruction, even if with our approach, sometimes it's really time-consuming. The reconstruction in this case is much faster.

Yes, thank you. I will translate it for Professor Wang.

Yes, I won't change my approach. Just imitate Professor Wang if possible. I'm not sure, but anyway, I will try.

Yeah, okay, I think it's a good method, and if you want to try it, we will connect and communicate for the experience about this method.

So I also hope you will have some comments to help us to improve this method.

Yeah. And this is, how long is the string? 10 centimeters?

It usually is 25 to 30 centimeters from the chest ligament.

Yeah, yes. And so, if I'm well understood, now you perform the lateral-lateral anastomosis,

and after you perform the esophageal anastomosis, right?

Yes, yes.

The length of this table is 4 centimeters or 6?

Yes, 6.

6?

6 centimeters, yeah.

45.

Ah, 45.

Okay, 45.

Sorry, sorry.

Yes, I'm not certain, but I thought that it was 45.

Thank you, Janine.

Dr. Lin was just a little distracted.

I'm confused.

Sorry.

Thank you.

I hope

Without any consequences for you

Oh yes

Okay

Thank you

Very well

Is it powered

Powered or the manual

We call it electric

Electric

Power

You wait

Some seconds before

Firing

Yeah, yeah. Before finding, you already have...

Yeah, so one minute, that's enough. Okay.

And now you close with running Sushu in a double...

We will close by Sushu.

Yeah, yeah, sure.

Anyway, that's true, this is a really extremely fast anastomosis.

Safe, really quick, fast, and very, very well.

Yeah, yeah, yeah.

Yeah. I think that I, yes, in the future, I want to imitate Professor Wan. I want to change my behavior. Absolutely, yes. And also, to me, dear Jamin, to me, it's really teaching for me today. Okay, thank you.

we will check

if there is some bleeding

and obviously

in this

fashion this is not

any stricter

the anastomosis is really broad

really large

obviously depends maybe

by the BMI of the patients

obviously

because if you have a patient with high BMI

It's not so easy, but anyway, I'm absolutely convinced that it's a really good approach.

Yes, the other thing I want to say is the tumor's location.

If the tumor was invasive, the EGC junction, so I don't think we can perform this.

Yeah, sure.

Sure enough, yeah, sure.

And so we usually perform it by the tumor located in the body of the stomach.

Yeah.

Yeah.

It's true that the IgE junction sometimes is really difficult to manage.

To the gastrectomy versus Ivor Lewis approach,

sometimes it's not so easy to choose the right approach.

Yeah, yes.

Yes, sometimes maybe if the patient was studied before,

sometimes you can have some surprise during the operation.

Very well.

I confess that I looked at my watch,

and now I realize that it's less than two hours.

It's unbelievable, unbelievable, unbelievable.

Yes, thank you.

Yes, it's a cholecystectomy.

It's the same time for a cholecystectomy.

Yes, unbelievable.

Unbelievable.

And I imagine that during an operating room,

you can perform three or four gastrectomies a day.

Yes.

That's possible.

Professor Wang, three or four gastrectomies is possible.

It's another thing.

It's different from us.

It's much better.

Yes, we are really surprised.

Every time we are surprised.

Because Professor Wang is really difficult to imitate him.

In a double layer or single layer?

Double layer.

Double layer.

Yeah, Professor Wang will shoot you at the cedar stone.

Yeah, yeah.

On the second layer.

Yeah, yeah.

Do you really think that's really useful?

I think it's more safe.

So your behavior is really, really, really useful.

Sometimes the surgeons ask their own behaviors.

Yes.

So many thousands.

I think that every surgeon thinks it's not possible.

It's not true.

Usually, we will have water in the first day, and the fruit food usually is two or the second

or the third day, and have the semi-fruit five days later, five days post-operation.

In a week, anyway, in a week the patient can start eating, okay?

Yeah.

Yes, in a week.

Usually we will discharge it, discharge it six days post-operation for distal gas ketamine.

And for the total gas ketamine, usually it's one week, seven days post-operation, we'll discharge it.

Yeah, more or less the same thing that we perform with our patients.

Yeah, I remember when I stated that.

I remember it's about, yeah, six, seven days, possibly.

It depends, obviously.

A few months ago, Jacobo sent me two patients.

Professor Huang have performed in 2019.

So they recovered really good.

Yeah.

Yeah, and you know that I, yes, I had the control, you know, one of these patients exactly one week ago.

You remember the women?

Yeah, I remember the women.

Yeah, the old women.

She is perfectly doing perfectly.

She is very, very well.

There's no problem about them.

And the women, I had the control with her just, yes, one week ago.

Yes, one week ago.

Perfect, perfect.

and the woman was

the delta-shaped

yes, delta-shaped anastomosis

yeah, you see

I think that Jacopo

sent to you the pictures

of the patients, they are

really, really

yeah, this is the picture

of the patients, you have the

Professor Wang saw

the pictures of the patients

yes, really, really, really good

oh yeah, I have a picture of the Professor Wang

And really, the last woman, it's true.

When I saw her 10 days ago, she told me,

please give my best wishes to Professor Wang

because she knew that we had a life surgery together.

And so, Professor Wang, I have the honor to give you the wishes of the last woman two years ago.

Thank you. If we have a chance, we will go back to Italy again.

Yeah, absolutely, yes. Soon as possible.

And Yao, now you perform a double loop technique.

Oh, yes, yes. We call it late cut.

Oh, yes, this is my passion. The double loop technique, yes, sure.

Really the double loop technique I think this is really useful in this kind of

operation, and just avoiding any incision in the abdomen

incision, it's much easier. It's about 10 centimeters from the esophageal

jejunal anastomosis, right? No, I think it's about 3 to 5

the suction drainage.

Yes.

How many?

How many?

One, two.

Two.

The same thing with us.

Perfect.

Come here.

you performed this year

in Fuzhou?

In this year?

More than 1,000 cases.

It's unbelievable.

That's unbelievable.

Unbelievable.

More than in Europe.

More than in all of Europe.

Jamin,

you go to Houston next year

or not?

No.

The World Congress of Gnostic Cancer

in Houston next year.

We will go there or not?

No, no, no.

No.

Because it's pancreatic.

really grateful to you, because it's a good, good demonstration how to perform

form, and total gastrectomy with a minimum invasive approach, and a three-stacks lymphadenectomy.

That's really rare to see, and without any bleeding now.

Yes, I've slowly tried fit surgery.

That's really, and with the sort of lymph, navigational lymphadenectomy with the green

the green and jocelyn really really beautiful yeah

Jacopo say the macho land today much later it's really hard to learn the

match and really hard to learn it's always really a great pleasure to us

seeing you at work thank you thank you really dr. Lynn yeah a really important

a really important and really useful message to you which kind of message I

say that Milan Milan Club this year is doing very well in Italy and you know

that Milan Club is doing really really really really really well that's a

really important message for you thank you thank you i like this message because i think i'm busy

i know yes we can say that at the end of your relation we can't talk about the meal and claim

Professor Wang will have two late sutras to close the conversation.

Thank you. Lesson of anatomy, a lesson of surgical skill, and a lesson of the great cooperation between you, just a team.

Professor Wang has formed an unbelievable surgical team, because this result is not possible to gain this result alone.

on, just if you have many, many different skilled surgeons around you.

And congratulations also for this great result that you reach in your career, because you

are a great surgeon, but you have a great team with you, and this is really your merit.

How many surgeons now are there in your department about gastric surgery?

Mr. Professor

Parisi.

Thank you so much.

I finished

my life surgery.

Yes.

In two

hours, you performed

a total gastrectomy with

a three-step lymphadenectomy.

So, can I

say to you, thank you so much.

Congratulations for all of us.

In Italy, Professor

professor palazzini you are really master of surgery you know i my i esteem you really the

best surgeons in the world about gastric surgery thank you so much thank you so much for you and

and you a beautiful team and my wish is to see you again as soon as possible at the end of

covid maybe in here in in italy internally just to perform another life surgery together

in our collaboration, our scientific collaboration,

and as we did several months ago,

like, for example, the multidisciplinary meeting.

And thank you, thank you for all your support.

Thank you, thank you.

Thank you, Professor Pettis, Professor Jacob.

Bye, bye, bye, a great honor to all of you.

Yes, my personal congratulations.

You are really beautiful.

All right.

Thank you so much.

Thank you, Professor Parity.

By the way, happy Thanksgiving Day.

Thank you.

Thank you.

Bye.

Bye.

Bye-bye.

Turn off my voice.

Dear online experts,

our online broadcast of Professor Huang Zhaoming's live surgery