Dr. WANG GUIQI First Hospital of Hebei

hello hello can you hear me hello good morning hi good morning nice nice to meet you professor

so on behalf of professor palestine i just want to thank you for staying with us today

in this huge congress that has come to the 34th congress in a row so we are now in the

So can you go on and present your case that you are going to operate on?

您可以开始做手术的时候介绍了,对。

我来介绍吧。

患者是一个34岁的男性。

他的主要代谢异常呢,就是一个血糖升高,血脂异常,血脂升高,带有就是光尿酸血症。

入院以后呢,FUFU CT也可以看到有一个特别明显的脂肪肝。

We are also seeing a fatty liver.

This is the basic of this patient.

So test can you hear us?

His height is 172 centimeters.

Over 115 kilograms with a BMI 38.

Okay.

So we are now mobilizing the liver and exposing the rest of the organs.

and it is a very heavy

liver as we can see.

Usually, we will use the symmetric method to mobilize the liver.

And we are moving from the middle of the stomach, and we will begin this work.

At this point, it is very easy for us to move into the perineum.

It has a multi-layered membrane.

membrane, and we are watching very closely at this port.

At the right hand, we were focusing on the right-hand portal.

On the right-hand side, the portal is a major point, and we have a 5-millimeter token at

the left-hand side.

right yes just in case and if it's not too much disturbed to you can you show us the the ports

the positioning of the ports is it possible

it is at the belly button around the belly button

We placed the right trochlea five centimeters above the belly button at the right hand.

It is at the exterior part of the muscle.

If necessary, we will start the fourth trochlea depending on the situations of this patient.

It is very easy for us to do the separation at the distal since we are offering the troca

if necessary we can do it twice.

It looks like that the exposition of the surgical field is great, probably due to the perfect positioning of the trochers.

So, Professor, how many patients do you treat per year of such a surgical procedure?

Around 1,000 per year.

Yes, every year, we did almost 1,000 patients on the sleeve trajectory gastrectomy.

For the bypass, OETB, around 10%.

The numbers are simply astonishing.

Yes, it is astonishing, a large number of patients we receive every year.

So the next question is, how many surgeons in your department are performing such a procedure?

We have seven surgeons.

And we have more professionals and specialists

on the nutrition as well as metabolism.

and we also have the health management specialist as well that means an average of

of 150 i mean 150 patients per surgeon per year that's a lot and it's an average of course

也是很好,也是很可观。

对,他这么来比一下,

就是看医生大概能够负责多少人,

这么来算一下。

这个一定能把胃小二次的气膜都分开。

So we have to mobilize the mini-membrane on the stomach.

扭力分离以后会保持好这个形状。

We have to maintain the shape of the stomach of the operation.

come into italy and we went so for poland venus and rome and uh

and so italy

From this patient's case, we can see the very thick spine membranes along the stomach.

so we are going to move slowly with the coagulation devices

but they are people for holding a lot of stress

And this is the right place for us to mobilize completely.

We have almost completed the process of mobilization.

We are using the China-made powder devices to complete the process.

It is four centimeters away from the pelvis.

The stomach water is also very thick, as we can see.

Do you have any gastric tube inside, Professor?

after the first help time.

for some of physicians and surgeons they will find these two steps vice versa they will

re-change the order they will place the stand in the first place before they are getting holding

but we want to make a better shape so we are using our own steps and our own practices

two centimeters movement and we're getting lower slowly so what's the diameter of that

endogastric tube move a little bit

yes exactly this is the place we want to hold it

Now we are going to check posterior and posterior of the stomach, the front and back of the stomach.

So from the beginning of the operation to the end of the operation, we will just apply the purple things.

Again, how many stapling? I beg your pardon?

This is the fourth stapling, right?

Now this is the fourth stroke that we applied.

Usually we will make it at the maximum level of 5 or 6.

The device is very smooth in operation with limited noises.

So we are going to do a high-density check whether we have already mobilized all the

words of the stomach.

The best way is to lift it up a little bit.

very thick stomach.

We definitely need an extra stapling.

It's very long, it seems to me.

Now we are going to do the encapsulation.

This barbed thread is also made by a Chinese manufacturer.

Previously, Johnson & Johnson is the only manufacturer. Right now, most of the Chinese manufacturers can also produce such barbed threads.

主任,主持人问你这个是每次都会缝线吗,还是看情况?

那您是不是每次都缝合?

我每次都缝合。

We would do it every time.

我每次都缝合。

Yes, every time we do suturing.

缝合可能不一定能减少弱的发生,但是可能能减少出血的发生。

purpose of suturing is to avoid the cases of hemorrhage or the bleeding it is not necessary

to avoid the cases of the leakage some surgeons perform this part of the intervention by

to the intervention

In case of the bleeding or hemorrhage, we can do a complete embedment.

At present, in China, we will do partial suturing or the complete suturing, but in the middle

segment, we'll usually practice complete the full suturing.

For the Italian colleagues, if you have time, please do not forget to visit our hospital.

though we could change our notes on the tips of the operations definitely we would love to and

as well we would like to invite you to the next congress to be held in 2024 you can be in presence

just like the almost 2 000 people attending again in presence of this great really great congress

Now we are giving away the ostent.

In China, we usually use the 36 to 40 in terms of the parameters.

We did it.

For the rest of the work, we're going to do variegation.

so are you going to stay with us on the video hi professors and colleagues are you going to stay

with us on the video about the rest of the steps such as irrigation and washing and cleaning

or i remember that you want to see the positions of the troika right

are you going to see the positions of the trees yes please yes please

The main board wants to maneuver, while on the left-hand side is the 10-millimeter observatory

port.

On the right-hand side, we are seeing the assisted port, and we made our own rules,

It's not like the general practices in China.

主席,他没忘了看麦克风,所以刚刚讲话没有听见。

他没有看麦克风,所以他刚刚没说话。

So professor, moderator, can you turn on the microphone, otherwise we cannot hear from you.

So you are new to yourself.

Here we are. Can you hear me now?

没问题,主任能听到吗?

您能听到我的声音吗,主任?

我们听到外方的声音现在。

Are you going to stay with us

on the rest of the procedures about the cleaning?

We almost are down, so moderate turn.

Yes, yes, it looks like the procedure is almost complete,

but anyway, so many young surgeons are attending this Congress

here in presence and also online.

So I would love to stay with you

until the very end of the procedure.

Sure, we will continue to work with you through the video.

Thank you for staying with us.

No problem. It's my pleasure.

And just taking into account that there are so many young surgeons attending this conference.

So we can also chat somehow.

and what about what about an abdominal drain so if i have a time please visit our hospital

we can do some on-site change

so i'm going to enlarge and expand this port a little bit

Because the patient has a very big stomach,

we have to enlarge the foot a little bit.

And I would use the forceps to continue.

Take it.

Yes, I will use the forceps.

So no polyethylene bag to structure the specimen.

Do you agree with that?

Generally speaking, yes.

Do you use a standard stand?

No.

It's easier to use a standard stand.

It needs a bigger hole.

That would cause the folding of the specimen.

That will lead us to further enlarge the port.

So we don't use that.

Okay, thank you.

Thank you.

So around 1.5 centimeters,

we can take it out.

It is less than two centimeters in terms of the diameter.

Now we're going to check whether there's any air leakage and we are going to inflate it

a little bit to do the test this is the specimen we have already get out is a complete resection

that round with we established a shape oh great idea to inflate the stomach

yes we have already inflated it just as whether there's any air leakage or not yes we did that

I also love the way you lift the left liver.

I like the way you lift the left liver.

We usually use this method, but if it's too big, it's impossible to expose the trachea.

For certain patients, if the liver is extremely large,

we have to use this specific method to alleviate this liver.

We are going to find a new gaze because it has been infiltrated.

We need a new piece of the gauze.

Do you plan to leave a drain or not?

刚刚是已经水洗过了,是吗?清洗过了,在里面。

已经处洗过了。

是的吧?

Yes, we have already finished that.

我们就去掉那个什么?

我们去到这个,我说它里面倒了。

好,我们就现在把它玩看看。

Yes, we almost done, so I'm going to say...

now we are going to do the facial suturing okay thank you and just some extra question for your

immediate post-operative period and do you have any diagnostic procedure after i mean in the first

or second post-operative day and when do you normally feed the back the the patient and what

What about the discharge?

I think that's you now.

Too many questions.

Yeah, no.

So I'm going to check with you.

Are you asking a question about the post-operative

or pre-operative diagnostic?

Post-operative.

I mean, no radiological procedure.

I just want to ask you,

how do you check the patient's recovery after the surgery?

Oh, what did you say?

Yes, what kind of arrangement do you have for the patient after the surgery?

So usually after the operation at day two, the morning of the second day, we'll offer

him or her an imaging check if there's any stomach leak.

If there's no such leak, we will generally regard this operation as quite successful.

So how about that?

is this the question you want to ask and if this answer you find satisfactory or not definitely

or any comments you want to give us yes the comment is it has been great to see you

and to attend your surgical procedure that was performed i mean completely great

really and it looks like your experience is definitely huge and i just want to thank you

on behalf of professor palazzini for staying with us and i really hope to see you in a very

near future and the nearest one is what are you going to perform now what time is it now in in

in china

so if you have any time just let me know we are eager to meet you in person as well

hi moderator so here we are yes yes we are very eager to meet you as well so we're so happy to

to have you as the audience to give me any comment.

Okay, it looks like everything has been convincing

since there is no question from the audience

that is a crowded one.

I just want to tell you the professor

and all the colleagues that you have been...

They see it clearly.

They think all the surgical procedures and techniques are very mature.

They are just learning.

They don't seem to have any doubts.

They feel very natural and willing to do it.

You have been in one of the major screens

in the audience and more than 2,000 people looking at your procedure right now directly.

And today at this conference, you are the most number of people in the operating room,

learning the most. There are also 2,000 local young people learning.

So I just want to ask, what time is it in China? Is it too late?

It's seven hours away. In China, it's about 15 o'clock.

And I do not have the number of the people attending your procedure, I mean online.

I am just telling the ones that are in presence now in Rome right now.

So we are seven hours behind the time zone of Rome,

so we are almost approaching 4 o'clock in the afternoon.

Thank you for your trust and your belief, and we want to meet you in person as well, as soon as possible.

I would love to, really.

I mean, me in China or you in Rome, that would be great.

I'm Umberto Grandi, I'm from Ravenna, that's in the north.

It's a city on the Adriatic Sea, some hundred kilometers north from...

Rome, but I'm a very close friend of Giorgio Palatini, and on his behalf, I just want to

thank you again for staying with us for this convincing surgical procedure. Thank you so

much, professors. Thank you, colleagues.

It's a great pleasure for me to be invited to take part in the

Congress on the Digestive System Congress and to have the honor of giving one live

now broadcast operation before the esteemed audience such an esteemed audience and I wish

I wish the conference a wonderful success thank you again thank you so thank you very

We might hope to see you very, very soon.

Thank you, Professor.

Thank you.

导人能面见您,想与您见一见。

好。