"Medical Everyone's Interview" is another high-end interview program in medical humanities produced by the original creative team after the broadcast of the documentary "Two Hundred Years of Surgery", aiming to share medical progress and show the value of doctors.
In a question and answer, a group portrait of ordinary, real and noble medical scientists is outlined, between warmth and reason, thinking about the meaning of life and exploring the origin of medicine.
We will excerpt the wonderful dialogue between director Shi Lan and Academician Dong Jiahong in the "Medical Everyone Interview". (q: director Shi Lan; a: Academician Dong Jiahong)
q: Hello, Dr. Dong, thank you very much for accepting the interview invitation of the documentary "Two Hundred Years of Surgery". As an expert in precision surgery for hepatobiliary and pancreatic diseases and a hospital administrator, what are your criteria for judging a good surgeon?
A: A good surgeon needs to have eagle-like eyes, a lion-like heart, and a pair of women's hands. What does that mean? That is, the eyes are to keenly observe and perceive the patient's condition and lesions, the heart of the lion, then you must be brave, single-mindedly to save and challenge these problems, to challenge the limit. A woman's hand is to be delicate and meticulous. That is to say, in our Chinese words, we must have both moral integrity and ability. Therefore, virtue is to have a broad heart and a love. The ancients said, "Those who are not close to the Buddha cannot be healed, and "those who are not close to the immortals cannot be healed." To be kind and skillful, this is what a good surgeon must have.
Q: So I think sutures should be an important manifestation of the surgeon's "magic hand"? So in the operation, which part of the suture is the most difficult?
A: Usually in our hepatobiliary surgery is the most difficult or blood vessels, if the blood vessels are violated, it is necessary to carry out the removal, repair and reconstruction of the affected blood vessels, which is often the most risky, because bleeding is a great threat to the patient, and heavy bleeding can lead to the death of the patient.
And the repair of blood vessels, from the technical requirements are also very high, the suture of blood vessels technology. If even a small treatment is not in place, it may cause the narrowing of blood vessels, the formation of blood clots in blood vessels, and finally the blockage of blood vessels, at this time it will fail.
Q: So I think the stitches themselves are also an important factor, right?
a: This silk thread can be said to have been used until the eighties of our country should be (twentieth century). It should be after the nineties that some undamaged sutures of this chemical synthesis gradually appeared in our country, and in the past the silk thread was very rough, the silk was woven thread, and its surface was not smooth. When the needle passes through the blood vessel wall, it will cause this kind of laceration on the blood vessel wall. And this stitch, the silk thread is worn in the eye of the needle and drawn out. This needle is not a suture without damage. When the needle passes through the blood vessel, the thread passes through the blood vessel. It can cause such lacerations on the walls of blood vessels.
In 1894, there was an assassination of the president in France that shocked the world. At that time, the French president Sardi Cano was punctured by someone who had punctured the abdominal aorta, and although the surgeon had found this ruptured artery in the wound at that time, the pressure of blood flow was very high, and there was no good technology to control bleeding and repair blood vessels at that time, and finally the president died. It caused a powerful stir in France, where the population accused surgeons of incompetence. In fact, the technical level was limited by the historical conditions at that time.
After Karel invented the three-point vascular suturing technology, it should be said that it opened a new era of vascular surgery technology.
The three-point stitch was first invented by the French doctor Karel in 1912. He first stitched three stitches on the two broken ends of the blood vessels to be anastomated, and three stitches at equal distance. Such a way is to separate the anterior and posterior walls of the blood vessel. Second, because these three points are equidistant, when the suture of this blood vessel is marked by three points, it can ensure the uniformity of this suture and the uniformity of the stitch, so that the narrowing of the suture of the blood vessel can be avoided, or the distortion of the blood vessel can be avoided. Karel's three-point stitching technique is a milestone in a technological advancement. He won the Nobel Prize for this.
q: In 2006, you first proposed "precision surgery" in the world, can you tell us about the background of this concept of time agency at that time?
Advances in technology have increased the certainty of surgical practice. With the significant increase in the certainty of surgical practice, we can achieve a precise balance between the three key surgical elements of lesion removal, organ protection and damage control, or to find its greatest common divisor. Because these three surgical elements are to determine the patient's treatment effect and determine the patient's prognosis, then we will use the most appropriate, for each case to make the most correct decisions and precise interventions, then to achieve the purpose of this surgical treatment is both safe and efficient, minimally invasive. Finally, the patient receives the best possible recovery.
At that time, I felt that such an idea and the technology or technical system guided by its concept should be defined by a new conceptual term. At that time, we thought of a lot of words called precision surgery, called exquisite surgery, called fine surgery, etc., and finally I proposed to call it precision surgery, precision surgery. This precision surgery can reflect the connotation of modern surgery.
Therefore, the development of the whole surgery, it is accompanied by the development of human civilization, social economy and science and technology is constantly evolving. In every era, surgery will be given new connotations because of these technological advances, which will lead to a change in surgical concepts and paradigms. Then it can be said that the development of modern surgical technology into the 21st century, that is, I mentioned earlier, it is still because of the integration of modern science and technology and traditional surgical methods, which greatly enhances the certainty of the surgical world, and is to promote the development of the entire surgical technology into a new era, called the era of precision surgery.
Under the guidance of the concept of precision surgery. Then, from the technical point of view, we are constantly innovating and developing, and a modern surgical technical system characterized by quantifiability, visualization and controllability has been formed. At the same time, it greatly improves the certainty of surgical practice. This allows us to maximize the preservation of healthy organs and optimally control the trauma information throughout the body while removing lesions, so that patients can get the best recovery.
Now this precision surgery technology can be said to have been widely recognized and applied in the world, it should be said that this concept of precision surgery is to promote a revolution in the field of surgery.
q: After entering the era of precision surgery, does that mean that the role of surgery is getting smaller and smaller?
a: In our Chinese words, we must have both moral integrity and ability. Therefore, virtue is to have a broad heart and a love. The ancients said, "Those who are not close to the Buddha cannot be healed, and "those who are not close to the immortals cannot be healed." To be kind and clever, this is an excellent surgery I think it can not be said that the role of surgery will be smaller and smaller, the mode of operation, the indications of surgical intervention, then this comprehensive application between surgery and non-surgery, will further improve, will change the mode of surgical treatment, improve the effect of surgical treatment. Of course, if we can find diseases or intervene in treatment at an earlier stage when surgery is not needed, and effectively intervene in treatment, then this kind of surgery may not be needed.
In fact, there are many diseases that used to be surgically necessary and have now been replaced by non-surgical methods. For example, the early liver cancer of our liver, the small liver cancer with a diameter of less than two centimeters. In this appropriately selected case, radiofrequency ablation or microwave ablation can replace surgical treatment and achieve the same effect as surgery. Surgery will not disappear in our foreseeable future, but the indications for surgical intervention, the mode of surgical intervention, and the combined application of surgical intervention and non-surgical treatment will change greatly.