Lettura Prof. Gong

Like, omentectomy, as we know, omentum, as the textbook showed, is the mass of gastro.

But when we use the CME concept to the gastro cancer, omentectomy, resectors, or non-resectors,

or do what we mean to preserve the same rhythm.

No difference.

Why?

Second, when we compare the CME...

Yeah, that was all fine.

Yeah, no problem.

Now, so these are our ports in Germany.

That's the one in Anglia.

If you turn the ribcage on that side,

this is sort of the...

They are almost the same rhythm.

This one's on the edge of the ribs, on the left-hand side.

The camera port, 15 millimeters in the midline, and this port is between...

We continue to compare.

We find out these are the data that come from the Italian, okay?

Right.

Now, the first thing that we see is this.

D2 and D1, there is OS or DFX.

Why is anectomy in colon cancer a good result, but in gastric cancer, no any effects?

At the same time, CME in colon cancer have a good result, in gastric cancer, no effects.

Why?

And the more strange is...

For that cancer, even example from the gastric cancer,

even no lymph node metastasis,

they have a big difference of survival.

Depends on invading steps.

For T1, T2, T3, they have big difference.

Even they have no lymph node metastasis.

What induces local recurrence?

We don't know.

So, we start a new model.

we call the distal gastrectomy or total gastrectomy

is two plus CME.

For right colon cancer,

we call the white colonectomy is three plus CME.

In this way, we make a very clear margin,

very clear concept, no any confusion.

Somebody asked me,

For colon cancer, for example, we use the right colonectomy, D3 plus CME, it means add this margin, make the ligation, and then keep the envelope as completely as possible, move out.

So according to this model, we go to two operations as the example.

Like the beans in genetics.

Genetic model describes the law of genetics using one bean.

We talk about membrane and epinephrine, we use two beans.

One bean is the gastric case, another bean is the colon case.

Okay, let's try this first. So in the gastric cancer, we found that maybe people

suppose that the omentum is the mastogastrum. That is the wrong description.

The real mesentery of the stomach is hidden beneath the omental and the outer side of the bust sac.

Our purpose is at the D2 ligation to keep this mesogastron as completely as possible and move up.

And this model we call the table model, the publishing model almost 10 years ago.

Okay, people can check our late literature.

So according to this model, we found that this is a right epiphyllic gastro-masonry.

Ah, this is a left gastric apipulorical mesentery.

You see, this mesentery is a left gastric apipulorical mesentery.

They are separated from the omentum, this omentum.

They have, they separate each other.

This is a right gastric mesentery.

Everybody knows I showed live surveillance for more than 500 in China and the world.

But people can say, how about this result?

Okay, here we collected almost 400 patients, 360 patients.

Go to the randomized control trial.

These 360 patients older than them is local advanced gastric cancer.

Not include early gastric cancer, also included very late stage, like stage 4.

So the results show that for nympho node harvest, D2 plus CME use this model is obviously higher than traditional D2.

At the same time, as people traditionally opinion, if you harvest more nympho node, you will get more surgical injury or damage.

But in this region, we get much less bleeding.

Why? Why? You get so many lymph nodes harvested, but your bleeding gets decreased.

That is a very good result.

And if we follow three years and five years,

DFS, disease-free survival, we found that D2 plus CME is obviously better than traditional D2.

The data we published, the three-year survival data, we published in BJS.

At the same time, OX also is an obvious difference.

This is the first separate data curve.

When we compare, people show maybe your D2

is not so standard.

We compare our D2 with other group,

like in China, class of one.

In Japan, in South Korea, class of two.

They are almost same.

These are our control. And our D2 plus ME for local recurrence gastric cancer, local

advanced gastric cancer, its survival is like 85%. It's very high. And before, it was very

difficult. These differences have a very good strategical result. And finally, we

can check D2 plus CME compared to traditional D2, bleeding get decreased, and at the same

time local recurrence also decreased. It means improve both at same time. So

according to this model we suggest maybe this picture people suggest is

Okay, outside a sock sack, a sock sack.

If we don't know this anatomy

and follow the traditional anatomy,

we will broken this envelope from time to time

and induce it cancer leak.

We call it cancer leak.

leak, like a nuclear leak, okay? And then damage the patient. And finally, local recurrence.

If we use the new model, we give the anatomical emblocker resection. Pay attention. It's called

anatomical emblocker resection, not histological emblocker resection. That is a big difference.

So we can escape this cancer leak during the operation so we can get a good result.

From gastric cancer, we have this very good result.

But what is happening in the colon cancer?

So we close another bin in the anatomy.

anatomy. We have two things. One thing is gastric cancer, another thing is right

colon cancer. So we use D3 plus CME here. And in the D3 plus CME for right

colon cancer, we found, we supposed, we have two according to four points to

to escape the cancer leak.

Okay, these are four point.

First is from the iliocoronical mesentery.

Second, from the transverse,

I mean, coronal mesentery

between the right gastroepipleric mesentery there.

touch each other from here. And third is from the merged area, these two mesentery.

They are merged in the central. Finally, we from here to erase the whole sample.

Okay, so let's check here. The first, we from Iliog colon mesentery.

We can very stable found an anatomical plan.

Pay attention please.

Anatomical plan is not histological plan.

So in this way, we can erase this masonry

from the masonry bed.

Okay, yeah.

This is a iliac column masonry.

You see, it's very easy to separate them.

I don't know here have some surgeons who work on colorectal surgery.

If we have somebody here,

yeah, most of them, yes, buy this. I showed this

live surgery in Berlin. It's very exciting for everybody.

Okay. So, yeah, you see,

separate the maxillary from the

the masonry bed. We call the masonry beds. Yeah. The bed for people sleeping bed.

Yeah. Okay. Second, we separate the merged arrow to masonry from SMAV and SMA.

And in this way, we could finish D3 ligation.

Okay, let's see. And for CME, people is afraid to do like that.

They think about, they suppose this is very dangerous.

But this is totally much safer than traditional CME.

because they follow the very special plan we call the anatomical plan.

Thank you very much.

This is the SMV.

You see, we can very easy to go to the plan and make the exposure.

And then finally we get the ligation.

So SMV, SMA.

A. And with this merged arrow, we keep this envelope as completely as possible and escape

the cancer leak. Escape the cancer leak. Today we show here just the D3-plasmid, and later we'll

show an unedited video about the D2-plasmid for gastric cancer later. So you see the envelope is

It's very completed, right?

Not broken, all broken.

And less bleeding, less bleeding.

And then we make the ligation and the bifurcation.

It means D3, it is the D3.

And cut the mesentery edge

beside the left margin of the SMA, yeah?

And also we show the middle colon vein here,

make the ligation.

And then cause the mesentery

just between the pancreas surface, pancreas surface.

Yeah, you see pancreas surface is shown here.

And then we follow the Helen's trunk to expose the assisted right colon vein and make the ligation and keep the other vein unligated.

This is the Helen's trunk.

okay the head is drunk then we showed associated right colon band and then

make ligation and bifurcation that's why we say the P3 plus CME have a

also is very good for people do the duodenal pancreas resection, we call

HWIPO, yeah. They found they can take very easy everything. Okay, you see. And this area we

call the tri-root area. It's a middle colon artery area. Okay. And after this

In this procedure, we are supposed to separate the right gastro-epidemiological masonry with the colon masonry.

So, first, we make a mark here, yeah, we make a mark here, and then we go to the stomach.

First, we could mark. So, we could go to here. If here have many surgeons who work at colorectal surgery, in this step, people always don't know which way is a good way.

If people understand the membrane anatomy, this way will become very enjoyable time, very enjoyable time.

Open the bust attack, we will find here, here we call the membrane bridge.

You see, open it. This is very stable.

If people recognize this right gastric epiphyloric masonry, this transverse colon masonry, they have the fusion each other here.

You see? Very clear. The margin. This is the momentum.

to Professor Duca.

He will show everybody any times, just enjoy it, okay?

Yeah, yeah, yeah, yeah.

People can just show you.

And we also organize some group in Milano.

Maybe next year or two year later, we'll go there.

We'll organize several group.

but I stay here for two weeks and tell them how to do that.

Yeah, step by step to do that, you see?

Okay.

So finally, we go to the fourth point.

We go forward, erase the whole sample and move on.

We don't start from the beside of the abdominal cavity,

just from here.

here there's a membrane bridge opener and you see separated very easy yeah

yes in this way we can keep this mesentery as completely as possible okay

now to find out the move the result the procedure field should be like that

SMV, SMA and make ligation everywhere should be added bifurcation and the mesentery removed should as completely as possible.

When we show this life surgery everywhere worldwide, people always ask in this way may be too much damage.

damage, too many damage about the lymphatic vessel, something, yeah, some nerves, okay.

We got a cohort review trial.

We collected more than 500 patients, local recurrence, and some of these early, okay.

We found that we try the lymph nodes much higher than conventional CME.

This is conventional CME.

This is D3 plus CME.

We also find them less bleeding than conventional CME.

When we talk with Professor Hockenberg, they always complain that in the uterus and the pancreas, they have a bleeding point.

I don't think that is a bleeding point. That is a confusion point of anatomy.

If we know the anatomy, no bleeding there.

And survival, you see, for total, D3 plus CME much higher than conventional CME.

This conventional CME in my group, this control group, and advanced colon cancer

compare D3 plus CME for advanced colon cancer also have a big difference.

Not only DFS but also OS.

And people always ask, your CME is same like Germany did?

Okay, we catch up. This is non-CME, Germany showed.

This is CME germ shield. You see, the data comes from Benz here. Benz is the student of Prof. Hockenberg.

He is Erlangen case center chief, right? And on control, it's like that. Almost same, right?

But it's 3 plus CME here. Very clear. Much better than traditional CME.

And when we compare with the D3, what will be happened?

And the data that we compare is come from a low way.

They call a D2, you see, for a radical like that.

D3, yeah, much better. They use a stage 1 or stage 2.

We also use a stage 1 or stage 2.

We are a control group. Conventional CME, the same like D3. The data is consistent with the people published from the east and west compare.

You see? But, you see, D3 plus CME for stage 1 to stage 2 colon cancer, the 5-year survival rate, almost 100%.

Almost. Actually, our data showed it's 100%.

But when we make the lecture, we just said almost 100%, because this trial will have to continue to observe it until people accept it.

And finally, we go to the improvement. The same thing like gastric cancer. Surgical effects, the bleeding is less and less.

And the local occurrence, recurrence, local recurrence also

doubled, decreased.

Decreased, doubled.

Okay.

In the anatomy, we found this very clear procedure.

Get two bins.

The two bins get two totally same results.

Okay.

Okay, so we describe the law of this anatomy.

In human body, not only human body, but in all life event, okay,

tissues, organs, even system, they have the feeding structure.

And these organs, tissues, systems, their feeding structure includes lymphatic vessels.

So they should be enveloped by proper fashion in cavity,

in a serous cavity.

They are enveloped also by the serous membrane.

In this envelope, not only have a primary lesion,

lymphatic metastasis, but also have another metastasis,

previous people called TD.

Today, we found this channel we call metastasis 5.

Our job is to resect this completely.

However, in our body, like that model,

although it's few.

And most of these masonry in broad sense,

they lie on and hide in the masonry bed.

If we understand this masonry bed,

understand this map, we will know,

oh, they have a very special plan,

we call the anatomical plan.

We can find a very special point to separate them and then cut them.

In this way, we can escape the cancer leak, also escape the bleeding leak.

That's why bleeding get less, that's why local recurrence get less.

If we don't understand that, okay, people can use traditional methods like this, okay?

Leave like this, bleeding, and cancer cells, they are leaked out from the envelope.

Even we can erase them, exceed them.

Oh, sorry.

exceed them, but during operation too much bleeding, the surgeons feel dangerous, take

the risk, and finally the patients suffer from their life because of local recurrence.

So, we get from the two beings, we get conclusions. We suppose the first or mental is not a mass

That's wrong. After today's lecture, please go to your textbook about anatomical grace, anatomical textbook, like a long man's medical embryo article textbook.

you show, this is a, or mental is a mesentery.

That's wrong.

Maybe it should be changed something.

Second, mesentery is an envelope structure.

But when you go to grace textbook,

go to long lines embryonic textbook,

you will find this is the mesentery is a double membrane

brain connect the intestine with the posterior wall

of the abdominal cavity.

That's wrong.

It should be an envelope structure, okay?

And this envelope structure is exist widely, whole bodies.

And the third, the local events,

like a lymphatic metastasis, like a metastasis of fiber, something, only in this envelope, okay?

And we should erase this envelope from the mesentery bed as completely as possible.

And this way, we can get less bleeding and a higher survival rate.

All this data induces a new map. We should have a new map. Otherwise, our operation will always stay with the old manual management.

If we have this new map, the new map called membrane anatomy,

me, automatic surgery will come in soon. Our laser or some other detector will detect the

membrane where it is and separate them automatically. I hope our students, they will see that day.

Thank you, Omer.

well this was an outstanding presentation and we are most thankful because of the fact that we have

you know this junior surgeon listening to it and this was very didascalic but when an outstanding

presentation like that is performed there are so many questions me personally have a couple of

questions maybe a little bit too complicated but i want to take advantage of your presence here

One, looking at our good friend, the chief resident from our group that is working in

Strasbourg with Professor Marisco, could be an answer to your questions.

These kind of results deserve a multicentric international trial.

But in terms of verifying the quality of this precision surgery, you cannot tell somebody,

do the same and let's see the results altogether.

together you want to test the accuracy of the membrane anatomy distinction do you think that

ai artificial intelligence in recording our gestures could be and had and had in order to

testify the quality and so compare the results and demonstrate all over the world that it's not

just professor gong but this is the way surgical oncology should be performed do you think that

AI is the next step? Sure. And then I have another question. Yeah, very good question. My colleague,

Dr. Wang, their team is collaborating with some AI, for example, for

global research. They use very special detector to re-establish a map of human anatomy based on

membrane. And then we can effect two fields. One field, when this

map occurs, we told CT and R, you should change your data calculated again.

You know, CT, they can show the blood vessel, they can show the liver, heart, lung,

but they didn't show the membrane.

If they recalculated this model,

they have to show membrane.

If people could try, you can use ultrasound.

You use ultrasound to detect the muscle.

You will find a very clear membrane envelope structure.

Okay?

And then another direction, membrane net infected.

we just here we just talk about medical industry okay first is CT MRC second is

the AI detection AI detection they should be use the light any light or the

radiation because radiation with different waves they will find out one

wave is very good for this membrane and detect them collect them and identify

For some subgroup of patients, surgeons have demonstrated a survival advantage when they performed D3 lymphadenectomy for gastric cancer.

But when you look at them operating, their D3 is a very peaking lymph node removal.

There is nothing to do with the idea of following precisely the embryological shield or membrane.

membrane. So how can you explain that they are demonstrating that in some specific subgroup

of patients, extending the just very peaking of nodes is better in terms of survival? There

is a contradiction, and I think that the results have a lot of biases, but how could you explain

it?

Yeah. For people, they say that if we defective a nymphal node, if nymphal node number gets

more, the survival will get higher. People believe that. But if you go to the

Sasako paper, Sasako proved they did D2, traditional D2 destruction,

compared with D2+, somebody called D3, along the aortic artery-ceiling group.

but the survival rate is the same.

Okay, the same.

Why?

When you broken the mesentery,

the lymph node deception will get less effects.

Will get less effects because of cancer.

How to prove that?

You can use a PCR to detect.

can compare D2, traditional D2, with the D2 plus 7.

You will find a big difference about the cancer leak cells,

cancer leak.

That has been published by you, right?

Oh, yeah.

Yeah.

We published the BGAs, yeah.

Thank you.

It's very good.

How is time?

Any questions?

So raise your hands and don't be shy.

Any questions?

Professor Pesciani, who is a-

May I have a water?

Yes, Professor. Oh, yeah, you want to drink something?

Yes, it's a bit foolish, I'm sorry, but you don't want to drink it, you don't want to drink it.

It's coming.

But Professor Presiani is a deep appreciator of this idea and he's applying it to rectal cancer,

so maybe he wants to know something from your knowledge.

Congratulations and thank you very much for your outstanding presentation.

What I want to say just, I want to remember what I experienced in your hospital five years ago.

That means that all the people participating in UR knew exactly what was happening.

So it means that the teaching rule of what you showed us today, I think, is amazing.

And so the minimally invasive surgeons, again, is the best way to know this membrane anatomy you showed in a very outstanding way today.

So just remember that what you showed us today is something maybe reproducible.

You are a very skilled and outstanding surgeon, but maybe I advise our colleagues to see in a live surgery what happens in your art.

And the last thing I want to say is that usually in the West, surgeons usually speed up their video.

What you saw today is the real speed, is the real way you perform your surgery.

So, again, congratulations.

procedure. It's much much earlier occur than medicine. When human is not human just like

animal. Some guys can use surgery like a broken like a bite by some other animals.

things. Three, we follow the geometrics. You have to try.

Yeah, there is somebody coming to you.

Yeah, okay.

I think they are present.

Okay. And everybody should connect to me. This is my email, okay?

Okay, yeah, and connect the email, you can email to me if I'm very busy, my secretary will reply to me.

Yeah, thank you for your time.

Oh, yeah, thank you.

So, let's go, we have the University of Italy.

Oh, thank you.

And the plate, remember you missed it.

Oh, okay.

I still believe that there are some questions before lunch,

lunch because we are waiting though the the bartenders to take us some small lunch so we can

stay together and discuss with them more freely in coffee we can talk to each other

thank you for your presence here and thank you for your presentation have a a question when a

a big lymph node interrupt the membrane, very bulky lymph nodes. Do you think that

that patient is surgically incurable, not curable? What do you think about a very

advanced disease. Yeah, very good question. So, we go to here. Okay. If the primary tumor is getting larger,

a lymph node is leaving. If we use a membrane anatomy, we can divide the cancer into three types.

Type 1, cancer in embryo, we should resect it legally.

Cancer out of embryo, we should not go to the surgery.

People go to oncology, to medicine.

The question is, have another type, we call cancer in the age of mass embryo.

In this way, we should go to new adjuvant chemotherapy or 5-in-4 chemotherapy to decrease it in the body and then go to surgery.

Okay?

Three types of cancer.

Thank you.

With this regard, that is a very interesting...

Thank you.

I think...

Have a rest.

Have a rest.

but let me ask this integration of the previous question professor gong now it's very popular

in order to have a map and to plan your operation and then verify it after it to use icg

now of course icg is not marking the affected nodes but it exactly indicates us where is our

limit okay can ICG as it is today or maybe in the next future some specific

dye identify those cancer that are seen radically curable like the ones that

you've been talking with him number three case or ICG is just you know some

more light showing where leaf nodes are but it's not adding anything in order to

show that they are inside or outside the memory you think that ICG can be used

we can move out, it is out.

They call this assisted to the lymphatic dissection.

The lymphatic dissection will open and blow,

even in the higher number of the lymphatic dissection,

but the cathodic still existed, okay?

Okay, we suppose we suggest we use dissection of the lymphatic.

We should use the recovery of the envelope.

Recover envelope means this area in the ground,

we recover from the out.

the out. Infected dissection means opening this gap and then make the water out.

We find we still have water in it, but that water can reproduce to a big bomb mass we call local

recurrence. That's why we shouldn't use the infected dissection. We should use the envelope

lobe recovered. So ICG, when people don't understand ICG, they just show, oh, this we

have some mark, we can make a dissection. But in this way, no useful for survival rate

increase it. And in my country, ICG company go to my lab, go to my division, showed, I

I told the member in anatomy, they said, yes, yes, you are right.

You don't speak this around, okay?

Otherwise, my business will be a failure, okay?

So we should take care of the business.

We cannot speak outside, okay?

They have their job.

Okay, thank you.

Yeah, yeah.

The last one.

And the last one is regarding the fact that in the West especially,

we are very concerned about economics.

So you have shown that this peculiar precision technique is bloodless, with more nodes.

What is happening with operational times?

Are these operations, the duration is longer than usual operation or not?

And second, also regarding economics, robotics and membrane anatomy,

Is something that could add quality or you think that robotics in this kind of wonderful surgical demonstration is not adding anything to the quality of surgery?

So, time of operation is longer. Is it longer? Robotics can add something to membrane anatomy precision.

because you don't believe in it for first question is uh for this member anatomy maybe people will

take a longer time sure people always use the rapid surgery before rapid surgery people and

is this year you do not use a rapid surgery you will use a rush surgery right and if we have any

the year, rush surgery, get out, but still have the rapid surgery. Today, we have to

survival save our patient. We should transfer to the precise medicine, also include precise

And when we use a new map, medical industry also will be changing to this direction.

We have tools, new tools. These costs will get short and the time spent will get less.

The first question. Second, about the robotic or laparoscopic.

Okay, both of them is imagine our view,

like currently use the telescope to see the moon,

to see our sky.

We will see all new structure we didn't find before.

So, what about robotic or laparoscopic?

Only if we have this map, the same result.

We don't have this method, we send better results.

Ok, thank you.