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Super minimally invasive surgery with no incision and no hole

If we were to take a questionnaire and ask people to choose the “most useless” organ in the human body, I believe the appendix would definitely be on the list. As recently as the 1980s, if you met a familiar and enthusiastic solo surgeon, you could even help cut out your appendix during the operation. At that time, it was widely believed that the appendix was not only useless, but also likely to cause appendicitis to torment people, so it was better to have it removed. But recent studies have suggested that the appendix may play a major role in regulating gastrointestinal immune function, because people who have their appendix removed for various reasons have a significantly higher risk of colorectal tumors years later than the general population.

Except for the appendix, the function of other organs we can say? Not really. As medical scientists continue to study, new discoveries are being made about the functions of various organs. For example, the heart doesn’t just pump blood, it secretes tumor suppressors; People who have had their stomach removed not only suffer from eating problems, but also from abnormal brain waves.

In fact, the human body has evolved over millions of years into a complete, sophisticated and efficient whole. Although the functions of each organ may seem obvious, most of them probably do several things, and what they do and how they do it is not fully understood.

After all, no organ in the human body is superfluous, and every organ should be treasured.

Organs are important, but when it comes to tumors, surgeons often have to throw the baby out the window.

The good news is that digestive endoscopes are slowly becoming all-rounders, allowing doctors to see what’s really going on in the digestive tract. It makes diseased tissue visible by shining light. It can spray medicine and absorb water. It can grasp, cut, sew, mend and so on. It can even perform an Ultrasound on surrounding tissue in a tiny digestive tract.

With this kind of help, digestive endoscopists now have super minimally invasive surgery for esophageal, gastric and colorectal cancers. The biggest feature of Super is that the esophagus, stomach and colorectal are left intact while the tumor tissue is removed.

Take the esophagus as an example, it is mainly responsible for allowing the food to reach the stomach. The seemingly simple wall of the esophagus is actually divided into several layers, including mucosal layer, submucosal layer, serous layer and muscle layer from inside to outside. The occurrence of esophageal cancer starts from the mucosal layer, and then develops slowly to the serous layer and muscle layer. At present, doctors are confined to the mucosal and submucosal esophageal tumors collectively referred to as early tumors.

For these early and early esophageal cancer, we will use the digestive endoscopy, gastroscopy, colonoscopy, etc.) in tumor tissues beside the esophageal wall to make a small hole to the submucosa, using the characteristics of organization loose here, by water injection to the submucosal layer of the tumor site and size film layer separation, can then be builders of the removal of the tumor.

As a result, the esophagus remains the same after surgery and the patient’s ability to eat is not affected. Super minimally invasive surgery allows many patients with esophageal cancer, gastric cancer and colorectal cancer to quickly return to normal life, and their life expectancy will not be shortened because of cancer.

While the effectiveness of super minimally invasive surgery depends on the surgeon’s surgical technique, the most important thing is that tumors quietly growing in the digestive tract must be detected as soon as possible.

Among the top five most common cancers in China, four are cancers of the digestive system, namely esophageal cancer, stomach cancer, colorectal cancer and liver cancer. Tumor of digestive system has definite region and heredity. The number of cases and deaths of esophageal and gastric cancer in China accounts for about half of the global total. We are used to treating patients with symptoms before going to the hospital, but for digestive tumors, this is too passive. Whether it is esophageal cancer, gastric cancer, or colorectal cancer, when patients have difficulty eating, pus and blood stool and other symptoms, usually in the middle and late stage, even if the medical skills at this time, the patient’s life is difficult to prolong.

From another point of view, although some patients with digestive diseases are clearly at high risk of cancer, more patients are sporadic in clinical practice. Most of the patients with early gastrointestinal tumors that we found clinically were found “incidentally” during gastroscopy and colonoscopy for other reasons.

So in recent years we’ve been recommending that everyone over the age of 50, regardless of whether they have gi symptoms, go to the hospital and get screened for tumors with gastroscopy and colonoscopy. People with a family history of digestive tumors and underlying digestive diseases should be screened at 40 years of age. Only in this way, it can be found and eliminated when the tumor buds!

As more early-stage tumors are found and removed, the way these diseases are treated will change. Therefore, IN 2011, I proposed a new model for the treatment of gastrointestinal tumors, namely, the model of digestive endoscopy as the main treatment, surgery as the supplement, and radiotherapy and chemotherapy as the supplement. The obvious difference from the surgical and endoscopic treatment model is that the new model is expected to help patients avoid a series of problems caused by organ resection and anatomical reconstruction. The new treatment model has spawned a new concept – super minimally invasive treatment concept.

Now that they are serious about preserving the original organs, doctors have really studied many new treatments. With these innovations, Chinese digestive endoscopists have impressed their counterparts around the world.

For example, gallstones and gallbladder polyps, which in the past were difficult to retain, are not necessarily so now. Using a technique called retrograde cholangiopancreatography (ERCP), an endoscopy surgeon can insert a guide wire from the intestine into the gall bladder through the natural tube that connects the gall bladder to the duodenum. When inserted, this guide wire can be deformed and stretched, expanding the narrow passage to a diameter of 5 millimeters, so that a subscope with a smaller diameter can be delivered and used to remove gallbladder polyps, comminute stones, and remove them. After treatment, support was released and the sphincter returned to normal. Gallbladder and bile duct are still there, but polyps and stones are gone. Similar methods are also applicable to the treatment of partial pancreatic cysts and appendicitis.

Or the treatment of achalasia from the cardia. Cardia is the fort from the esophagus to the stomach. If the muscles here are too tense, they will tighten up and the patient can’t swallow anything. The procedure used to be a giant thoracotomy. Now digestive endoscopists can create a passage through the wall of the esophagus to the muscle layer of the cardia, and then cut off some of the muscle fibers with precision, easily curing the disease.

Then there is bariatric surgery, which has become popular in recent years, in which most of the stomach is removed in order to stop the patient from being a voracious eater. Now digestive endoscopists are trying to sew a “chamber” from the inside of the stomach, allowing only part of it to work. In this way, after successful weight loss, the “chamber” can be reopened and the patient is given a complete stomach.

In the future, new technologies guided by the concept of super minimally invasive will continue to be created, allowing us to treat diseases while preserving every organ that nature has given us.

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