Precision in liver surgery.
Continuous theoretical and technological progress in the face of increasing expectations for quality health care has transformed the surgical paradigm. The authors systematically review these historical trends and propose the novel paradigm of "precision surgery," featuring certainty-based practice to ensure the best result for each patient with multiobjective optimization of therapeutic effectiveness, surgical safety, and minimal invasiveness. The main characteristics of precision surgery may be summarized as determinacy, predictability, controllability, integration, standardization, and individualization. The strategy of precision in liver surgery is to seek a balance of maximizing the removal of the target lesion, while maximizing the functional liver remnant and minimizing surgical invasiveness. In this article, the authors demonstrate the application of precision approaches in specific settings in complex liver surgery. They propose that the concept of precision surgery should be considered for wider application in liver surgery and other fields as a step toward the ultimate goal of perfect surgery.
Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China. Dongjh301@163.com
Jiahong
J
Dong
Shizhong
S
Yang
Jianping
J
Zeng
Shouwang
S
Cai
Wenbin
W
Ji
Weidong
W
Duan
Aiqun
A
Zhang
Weizheng
W
Ren
Yinzhe
Y
Xu
Jingwang
J
Tan
Xiangyang
X
Bu
Ning
N
Zhang
Xuedong
X
Wang
Xianqiang
X
Wang
Xiangfei
X
Meng
Kai
K
Jiang
Wanqing
W
Gu
Zhiqiang
Z
Huang
D003661:Decision Support Techniques; D003952:Diagnostic Imaging / Q000379:methods; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D011237:Predictive Value of Tests; D016896:Treatment Outcome