Zhang LEI

First of all, I would like to take one minute to tell you a little bit about our institution.

I'm from the First Affiliate Hospital of Xi'an Jiao Tong University, and we are founded actually in 1937.

We actually are relocated from Peking University School of Medicine, and we renamed and joined the Xi'an Jiao Tong University in 2000.

And we are a grade-A tertiary hospital under the National Health Commission.

And we are now currently on the progress of building a national medical center.

And the Department of Abdominal Surgery and Geriatric Surgery was founded in 1987

by our national renowned surgical expert.

And their department was renamed geriatric surgery in 1994,

integrated into the hospital's hepatobiliary disease hospital in 2011.

And last year, they fully relocated to the international Lamport campus in 2024.

as a part of National Medical Center construction and renamed the current title.

Actually, in that campus, it operates as a comprehensive surgical ward

integrating hepatobiliary, gastrointestinal, urological, and oncologic services

adhering to the strengthened specialized disciplines and optimized comprehensive

intensive care orientation and i would like to also introduce our operating professor professor

zhang lei and he is associate chief physician and master supervisor and deputy director of abdominal

surgery at first affiliate hospital of xiangzhou university he specializes in laparoscopic and

and colloidal coloscopic surgeries for abdominal diseases,

especially hepatobiliary and gastrointestinal diseases

with thousands of successful complex cases

and no major complications.

He has published over 10 academic papers

and we presided over multiple provincial research projects

and host two national patents.

and our anesthesiologist today is Professor Guanbin

is a member of transplant team

and in the department of anesthesiology

and operating team.

Here's our patient.

Mr. Zhao is a 60-year-old male

with a body mass index of 34.

He was admitted to the hospital

with chief complaint of intra-hepatic bile duct stone

detected over seven months and abdominal pain exaggerated for 10 days.

He has seven-plus months of intrahepatic bile duct stones with no prior treatment.

And 10 days ago, he suffered from paroxysmal upper abdominal pain,

especially after a meal and with no associated with other symptoms.

And magnetic resonance imaging showed a higher bile duct stone and intrahepatic bile dilation and poor CBD-visceral agitation.

He actually underwent a prior cholecystectomy.

So this is a redo patient.

And here is his past medical history.

He has a hypertension over 10 years with a maximum recorded pressure of 150 over 120 and controlled well.

And 81 years ago, he underwent a cholecystectomy with cholecystectomy, and details were unknown for over 28 years ago.

ago and now currently he was diagnosed with a over NCT we can actually visualize these the

dark stones appeared and gallbladder not visualized and with enhanced abominable CT

we can visualize multiple extrahepatic biodextrins with intra and extrahepatic biodextrins dilation

and possible complexes of left kidney.

So we have actually, we have two surgical plans.

After consulting with patients and the family, we chosen the laparoscopic common biodextrin exploration.

And after the exploration, Professor Zhang will see and continue with the operation.

And that's a little detail of this procedure, Professor Grandy.

And without further ado, I can give the mic to Professor Zhang Lei on the operating table.

Thank you. That's completely clear.

year so we are aiming to see the procedure and we are very curious about that once again i have to

thank you so much for staying with us today in this congress i mean we are so proud to help

our close friend is giorgio palazzini his congress is getting every year bigger and bigger

So let's go on. You are on the main screen of our usual and I thank you so much for introducing the patient, introducing the procedure, introducing also your skilled surgeon operator. Thank you so much, sir.

So we temporarily changed it to this patient.

Because this patient has undergone an operation.

And the patient may not be as good as the patient in the official letter.

But the real world is like this.

Professor Zhang welcomes everyone to his operating room,

and especially Professor Grundy to be our panel expert today.

And actually, he explained that while the delay, the other patient was prepped for today, but for other reasons, he had to change to the current patient and the current procedure, and he wishes to apologize for the delay.

And we can cut the video of the scene, the in-house screen, or something.

I can't see anything now.

No problem at all for the delay.

You know, we are six or seven years, seven hours late, respect of you.

So no problem at all. Thank you, sir.

Mr. Zhang, I've explained. Let's cut the scene.

Is there any possibility to see the trucker positions and the surgeon position?

Including the position of our body, the display of the mirror,

and the V-bar model.

We changed the V-bar model to the main screen first.

We didn't cut the video first.

Then let us introduce you to our operating room.

Let us introduce our anesthesia and surgery team.

I'm now asking the video operator to show the entire OR and introduce our OR team to our audience.

And this is actually, this is our OR20 of our international LANDPORT campus.

And as you can see, we have a modernized, complex OR, and now the videos are more clearly.

we can now introduce our surgeon today and to our left is our professor john lay as you can see

due to the uh and 20 year 28 year ago the patient underwent a laparoscopic or i believe it's an open

cholecystectomy. So the adhesion of inside the abdominal cavity is pretty severe. He is actually

using a very steep angle cutlery to release the adhesion. To our right is Associate Professor

Professor Lu Qiang, our attending physician today.

And in the middle, actually, to our right is our scrub tech today.

今天我们台上是哪位老师啊?

台上的护士呢?

台上护士叫啥名字?

郑兴凯。

原兴凯。

原兴凯。

and taking a little time to wave at our audience

and continue to the releasing of the adhesion.

Thank you, Xiaoxian. Thank you so much.

We, some of our outsiders may think that our lab colleagues are the easy ones, but in the

to our experience, the easy ones are not

ours to operate. Most of our procedures are

redos and triple dos. They adhere

all the places. Adhesions are everywhere

and Professor Zhang is currently trying to

establish another port to

assist with the

with the release of the adhesions.

Mr. Zhang, this should be the big curve, right?

The upper abdomen, the big net, the horizontal length,

and the abdomen form a wooden adhesion.

This is everywhere.

The curvature, the colon,

and everything is here.

So Professor Zhang is now using an ultrasonic scalpel

and also our domestic one is called Sensages.

I believe you have seen or hear about this company

since Mandarin, Mandarin, I'm sorry.

This is actually a large, complex medical supplier in China, and their product is actually pretty good.

Previous cholecystectomy has been performed in 1997.

I don't know if this was a laparotomic or laparoscopic procedure, but anyway, the adhesions are huge.

Exactly, exactly.

Yes, this is an open surgery 28 years earlier, and we cannot continue without all the adhesions.

We just have to be patient and take our time in this procedure that's necessary to be performed

I mean calmly and easily. Yes exactly exactly Professor Grandi your point of patience is the

key I believe also in releasing all these decisions is very easy to regret an earlier

rushing step you can you can see this is very densely adhered to the abdominal wall

嗯,张士年,就是说你这个游历的也很有耐心啊,然后,哎呀,这剪刀都用上了。

对,这个地方粘的很厉害,就是怕把肠子损伤了,所以我用剪刀组织剪的分离,就是需要耐心。

Professor Zhang is now using a sharp dissector to release the transverse colon from the abdominal wall.

do you perform also endoscopic procedure in your department i mean i mean in your

your colleagues and your surgeons endoscopic procedures

Professor Grandy and Professor Zhang said earlier that

that we have a dedicated sub-specialty.

Is it Professor Zheng Xin?

No, it's Professor Sun Hao.

Yes, Professor Sun Hao from also our hepatobiliary hospital

specializes in the endoscopic procedures.

And he himself does not operate that much endoscopically.

Thank you.

Matthew described precisely that we are now entering a trend of mixing procedures,

of hybrid procedures. Actually, I'm from the department of thoracic surgery. We do a lot of

bronchoscopies and also procedures under bronchoscopy.

you are exactly right

surgeons

starting to learn

endoscopic procedures

and our

internists especially

like

nephrology department

of our hospital they are

doing

all the laparoscopic

work with the

dialysis

tube insertion etc

it's not quite the same in my my experience I mean I work in a small

hospital I live in the northern part of Italy Ravenna that's a very old city

it's about 600 years older than Rome and our hospital is more because our city is

small it's only about 1,700 people so it's we have a unique public hospital in

Rowena and we search we surgeons we perform surgical procedure and the

endoscopic endoscopic procedure are performed by gastroenterologist and

There's a big difference, I think.

What do they do before you? Do they do ERCP?

Inner mirror. Inner mirror, micro mirror, long mirror, ERCP.

Because they don't have a lot of resources.

They belong to a smaller city in northern Italy.

We are introducing each other.

uh i'm sorry professor grandy i i wasn't following your city's name i you're from northern italy and

your the name of your town is ravenna r-a-v-e-n-n-a it's on the adriatic sea it's in between

venice and rimini right on the coast of the adriatic sea it's six kilometers from

阿德里亚海的海岸边上,叫在非常有历史的一个小城。

You said it's 600 years before the establishment of Rome?

Yes, right.

Yeah, that's very, we are from the city of Xi'an, another, if you are interested, ancient history of our hometown.

town we have uh over uh i believe uh four to five thousand years ago uh the city of qian is actually

the capital of the asian china so well in dark perceptive perspective we are quite alike and

how many people living there uh currently uh there are uh i believe uh a hundred uh i believe uh 15

西安有一千五百万人吧。

一千多万。

一千两百万。

Twelve million residents are currently residing in the greater Xi'an prefecture, the greater Xi'an city.

And the inner city hosts about five million residents.

I'm always astonished by the numbers of your procedure, your inhabitants and so on.

As I told you, my city is 170,000 people living in our city.

So I told Professor Zhang that after the procedure, he can see my screen and hopefully he'll visit Ravenna someday.

Why not? It's so historical and very well known because of the mosaics. I'm sure you can Google some mosaics.

world heritage

巴数

巴数这个联合国教科文组织的

世界遗产

他们的一个城市吗

对

还不少呢

Yes, Professor Zhang is amazed

by how many

到这一会儿

美国

世界遗产

have

eight of them

Yes

Yes, eight monuments of UNESCO, right.

i was explaining to professor john that i i did two lobectomies

vets lobectomies today and just got off the or table and uh we

we will schedule for a uh for a up to new live procedure and here we are

That was a tricky part of the procedure.

We can see the light at the end of the tunnel from here.

And after the adhesion, we can jump on to the procedure.

Professor Zhang is on the progress of exposing the hylum, we can now see from the screen.

Yes, the adhesion also acts as a retractor.

and he doesn't have to doesn't need another hand to help him retract the liver this is an

upside actually of the adhesion right sometimes the adhesions are just another hand

sometimes not not all the adhesions has to be removed

This is the scar of the previous cholecystectomy.

Dear professor, you just have to be patient.

I know probably it's boring for you, but I'm quite sure that all the audience,

that so many young surgeons are there, so they can appreciate everything.

I mean, also these movements, these calm movements that you are performing to release all the adhesions.

Thank you. Thank you, Professor Guangfei.

Yes. Patience and visualization and patience is the key,

as Professor Zhang said, when releasing the adhesions.

Yes, we have successfully exposed the

the common bile duct here.

And the duodenum should be under the goads.

Yeah.

Yes, yes, professor, exactly.

The left hand is pressing the serosa of the duodenum

and currently exposing the heritage of the

the Fast Koli, I suppose.

We are also facing the history of the Danang, right?

This is the Danang bed, isn't it?

Yes.

Let me see.

Open it, I'll get it for you.

I'll give it to you later.

It's a little bit of a problem.

Yes, using the ultrasonic scalpel,

on the topic of heritage, the professor Zhang

is now exposing uh the gallbladder uh the heritage from 28 years ago the heritage of gallbladder bed

now duodenum to our right is the common bio duct

is it the same word also in chinese i mean the gallbladder bed is just the same in italy

in italian yes exactly

海南管是在哪一块?

Last year, Professor Zhang believed this is the level of the hepatic duct.

And the common bile duct actually has strictured.

And he is now trying to expose the common hepatic duct and try to open from here.

10 years earlier, I was

rotating to his

service, and

Professor Zhang was my supervisor

in the

hepatobiliary

surgery. And we did

all this procedure openly.

I stood on the table

for

four to six

hours, and

we washed, rinsed

with saline, and

and collect stones, and now they do all this procedure laparoscopically.

您问一下他们,如果这个病例在他们了,他们是做URCP吗?还是做胆肠吗?还是做啥?

哦,Professor Grundy, Professor Zhuang wants to have your opinion on this case.

case we will do a endoscopic procedure or we will do a duodenum and hepatic duct anastomosis

or jejunum hepatic duct anastomosis or we will do the same procedure as he is currently performing

I think so, yes. If there is no problem, probably an ideal colidocolitotomy would be great. What about your opinion, sir?

I'm not, and of course, I'm a thoracic surgeon.

You told me, I mean the professor.

He is now opening the hepatic duct and on the MRCP they have observed a structure on

the level of lower bile duct so the endoscopic procedure is not quite feasible so he chose

the laparoscopic

procedure

what about the jaundice of the patient

the patient does not have jaundice

never

experienced any

discoloration of the skin

he never experienced any fever he only the patient only complained about pain

by its pain quadrant pain yes yes opening the jewelry box here is our

is the stone and the pain is due to the stones.

So probably this is the best procedure you can imagine.

Yes, Professor Zhang also discussed about why not retrograde

with cholangiopranchiatal pancreatography.

Because of the lower level structure of this patient,

in this patient,

he feared that a retrograde incision of the duodenum

will lead to severe complications

This procedure may be old-fashioned, may be a little bit of hassle, and the patient will benefit, he believes.

Let me turn off the mic for a second.

Can you see it?

Can you take a picture of it?

Turn it over.

The camera can't turn it over.

There is a line here.

I want to take a picture of it.

I took a picture of it.

Can you move this?

Let me try.

Gao Shan, can you see it?

Yes, we can see the endoscopic images.

Yes, we can see the endoscopic images.

Can you see it?

这个人胆子在下段还是有狭窄,还是有狭窄。

We can see a structure of the lower common bio duct.

Yes, the scope is actually now pointing towards the duodenum, pointing downwards.

现在镜子朝下嘛,对吧?

对,还是有点狭窄。

那你给他撑撑不,这个地方?

不撑啊,因为这个人他又没有黄蛋,

也做胆肠也是比较适合的

但是病人自己本人他不愿意做

因为他没有其他的心理

他就是个胆脚疼

而且这个胆道

其实里面的黏膜是很光滑的

并没有说那种毛躁啊

那种炎症

所以我想这次做完了

也许你再管个十年

甚至十五年

他不犯

也许这一辈子也就够了

这现在多大

65了吗

现在是多少岁

65岁

This is the view towards the liver.

We can see another stone, and he is now trying to extract it.

I don't think I can see it.

I'm looking at the bottom.

It's possible that it's going to go down.

Do we still have to look at it?

Then I won't move.

There's nothing to see, right?

Nothing.

Let's take a look at the top.

I'll take a look at the inside of the high-rise building.

It's basically over.

Just close it.

You have to close the dry-fuel pipe, right?

I'll check again.

If there are no stones, I'll sew them together.

that the tissue is actually ideal for primary anastomosis, primary suture. Spare the patient

from wearing a t-tube for over a period of 12 weeks and therefore more better ambulatory

effect and better patient outcome and patient comfort of course kind of procedures yeah

colleague i'm so sorry but we had a problem with in the last three minutes i mean the laptop was

upgrading to something so we couldn't see i i couldn't i couldn't see anything in the last

a two or three minutes and i've just called the technician that fixed the problem so

can you i'm so sorry can you repeat what uh what's the program what's going on uh professor john

for the past two two to three minutes just finished a final pass of the scope and

And he visualizes all the branches of the bile duct and all other abnormalities.

And he will use a continuous barbed wire to suture, to primarily suture up the hepatic duct and call it a day.

And he stated that currently he is now performing more primary suture rather than let the patient wearing T-tubes for a period of 12 weeks.

Overall, this procedure is a better solution for this patient, for this exact patient,

for his lower level duct structure, for his primary symptoms are related to stones rather

rather than stricter.

Yes, right.

So here you'll note.

I'm so sorry.

I couldn't see the extraction of the second stone.

It was right in the moment of our laptop.

Well, it was upgrading to something.

I don't know what.

But I'm quite sure it was a problem only of this PC.

see and the audience can see everything i think i'm so sorry i'm not i'm the only one that couldn't

yeah it's another pass of the scope it is uh now i believe he is trying to suture up the

hepatic ducts and finish the procedure yes he is now using a what kind of suture will you use

professor grandi this i believe is the kovidian uh 180 kovidian 180 barbed wire suture

again i'm so sorry i beg your pardon same problem just solved hopefully solved by technicians

chance in oh of course no no worries professor grandi uh currently professor john is on the

progress of sewing up primarily suture of the common bio a common hepatic duct

using a covidian 180 i believe barbed suture for continuous closure of the common hepatic duct

thank you and we also would like to thank the uh the conference uh for letting us to show our

hospital to display our procedure and have a very nice communication and discussion with all the

our italian colleagues and we hope to have you here soon sometimes i hope

later i hope and to host you uh to for a sightseeing tour of our city and our our campus

I think Mr. Zhang's choice is very right.

It depends on the symptoms, Brother Qiang.

He can hear everything you say.

He can hear everything you say.

No, Gao Shan can hear everything you say.

I definitely understand Chinese.

We don't have the same accent.

We have different accents today.

You say a sentence, I say a sentence.

Right.

Right.

You're still live.

According to our Italian viewers, they're still looking at you sewing the pole.

Using our 3-0 line to sew the pole.

Okay, the last stitch.

Okay.

Okay.

Okay.

Okay.

Okay.

Okay.

Okay.

Okay.

That's too good.

Bravo.

That's it.

It's over.

Although this is quite common to us,

there is still a little bit of pressure when it comes to live streaming.

I'm afraid I'll mess things up.

I was going to pick another more interesting patient,

but it turned out to be even more interesting.

We have now concluded our procedure and we can call it a day. Thank you.