Jiliang Shen

Laparoscopic hepatobiliary and pancreatic (HBP) surgery necessitates mastery of intricate anatomical relationships and precision-dependent techniques. This review synthesizes advancements in simulation-based training and education modalities— three-dimensional (3D) printing, virtual reality (VR), augmented reality (AR). 3D-printed models provide unparalleled tactile fidelity for patient-specific anatomy replication but lack dynamic physiological responses. VR enables risk-free procedural repetition and AI-driven skill optimization, yet struggles with haptic authenticity. AR bridges preoperative planning and intraoperative execution through real-time holographic navigation but faces challenges in cognitive load management. Future advancements must prioritize hybrid simulation ecosystems integrating biomechanical realism with adaptive virtual interfaces, validated transfer-to-practice metrics, and ethical frameworks for emerging technologies.

Background/Objectives: Ropivacaine is primarily metabolized by the liver. High doses of ropivacaine, combined with altered pharmacokinetics due to hepatectomy, raise concerns about potential drug toxicity. We investigated the impact of LMH (laparoscopic major hepatectomy) on the pharmacokinetics of high-dose ropivacaine. Methods: Ten patients undergoing LMH received a BD-TAP (bilateral dual transversus abdominis plane) block with a high dose of ropivacaine (3 mg·kg⁻¹ in 60 mL). Plasma concentrations of total and free ropivacaine and AAG (alpha-1 acid glycoprotein) levels were measured. Liver volumes were calculated using three-dimensional liver reconstruction technology. Results: The peak total ropivacaine concentration occurred 45 min after the block, reaching 2031.5 (876.0) ng·mL⁻¹, with a tendency to exceed the toxicity threshold in patients with a CFLV (cut functional liver volume) exceeding 199.24 mL or a CFLV/TFLV (total functional liver volume) ratio surpassing 18.61%. The peak free ropivacaine concentration, 111.5 (31.3) ng·mL⁻¹, was observed 90 min after the block, potentially exceeding the toxicity threshold when CFLV exceeded 452.33 mL or the CFLV/TFLV ratio was greater than 42.16%. Plasma AAG levels increased approximately 1.5 times within 24 h, from 1519.7 (422.6) μg·mL⁻¹ preoperatively to 2253.6 (460.4) μg·mL⁻¹ postoperatively, effectively reducing the toxicity risk associated with free ropivacaine. Conclusions: Preoperative administration of high-dose ropivacaine can be safely utilized in patients undergoing major hepatectomy. The increased plasma AAG concentration due to surgical stress reduces free ropivacaine levels, enhancing patient tolerance to the drug. The CFLV and CFLV/TFLV ratio may be supplementary indicators for predicting ropivacaine toxicity.

Background: Changes in pancreas volume have been reported in many disorders. In clinical practice, pre-disease total pancreas volume (TPV) is often unavailable for patients with pancreatic pathologies (e.g., tumors, cysts, or pancreatitis), as prior imaging may not exist or may reflect abnormal volumes. While three-dimensional (3D) computed tomography (CT) reconstruction provides accurate TPV measurements, its utility is limited in these scenarios, necessitating a predictive formula. However, no widely clinically accepted standard pancreas volume (SPV) formula currently exists. This study aims to develop an SPV prediction formula based on 3D CT reconstruction and the characteristics of Chinese adults. Methods: The TPV of 377 Chinese adults were obtained via CT 3D reconstruction estimation, 287 of whom were used to construct the formula and 90 of whom were used to validate the formula. The associations of age, gender, weight, height, body mass index (BMI), and body surface area (BSA) with TPV were assessed using Pearson correlation analysis. Stepwise multiple linear regression analysis was used to identify the independent correlation factors that could predict TPV. Results: Age, gender, weight, height, BMI, and BSA significantly correlated with TPV. In addition, stepwise multiple linear regression showed that BSA was the only independent correlation factor for TPV. Therefore, BSA was used as the factor in the following formula for calculating SPV: SPV (cm³) = 52.40 × BSA (m²) − 21.33 (R²=0.384). Conclusions: We created a BSA-based formula to predict SPV in Chinese adults. It can be used to evaluate pancreas volume changes in patients with diabetes or other pancreatic diseases.

Exposure of the hepatic artery is a fundamental step in many surgeries, during which iatrogenic hepatic artery injury may occur. Although the incidence of hepatic artery haemorrhage is low, its occurrence can lead to life-threatening haemorrhage. It is difficult and dangerous to accumulate clinical experience in laparoscopic hepatic artery repair in actual patients, and simulation training models for laparoscopic hepatic artery repair are currently lacking. In this study, a 3D printed model was designed to simulate the training curriculum for sudden hepatic artery haemorrhage, but whether training with the 3D printed model could yield superior skill improvement for surgeons remained to be determined. A new 3D printed model was designed for this study. Surgeons from the General Surgery Department of Sir Run Run Shaw Hospital participated in this simulation training. The surgical performance of each model was compared, and the authenticity of the model was evaluated and mechanically tested. Experienced surgeons performed better on the 3D printed model. After repeated training, inexperienced surgeons showed significant improvement of their laparoscopic hepatic artery repair skills. The authenticity of the model was generally satisfactory, but shortcomings persisted in the mechanical testing of artery wall tearing, necessitating further improvement. Few studies have investigated laparoscopic simulation training for sudden hepatic artery haemorrhage. This simulation model distinguishes surgeons with different levels of experience and allows those with less experience to improve their laparoscopic hepatic artery repair skills through training on the model.

Aim: A new simulation model and training curriculum for laparoscopic bilioenteric anastomosis has been developed. Currently, this concept lacks evidence for the transfer of skills from simulation to clinical settings. This study was conducted to determine whether training with a three-dimensional (3D) bilioenteric anastomosis model result in greater transfer of skills than traditional training methods involving video observation and a general suture model. Methods: Fifteen general surgeons with no prior experience in laparoscopic biliary-enteric anastomosis were included in this study and randomised into three training groups: video observation only, practice using a general suture model, and practice using a 3D-printed biliary-enteric anastomosis model. Following five training sessions, each surgeon was asked to perform a laparoscopic biliary-enteric anastomosis procedure on an isolated swine organ model. The operative time and performance scores of the procedure were recorded and compared among the three training groups. Results: The operation time in the 3D-printed model group was significantly shorter than the suture and video observation groups (P=0.040). Furthermore, the performance score of the 3D-printed model group was significantly higher than those of the suture and video observation groups (P=0.001). Finally, the goal score for laparoscopic biliary-enteric anastomosis in the isolated swine organ model was significantly higher in the 3D model group than in the suture and video observation groups (P=0.004). Conclusions: The utilisation of a novel 3D-printed model for simulation training in laparoscopic biliary-enteric anastomosis facilitates improved skill acquisition and transferability to an animal setting compared with traditional training techniques.

Background and Aim: We aim to summarize the current status of research on the role of exosomes in liver fibrosis.Methods: A review of the relevant literature was performed and the key findings were presented.Results: Most studies focused on the role of exosomes derived from mesenchymal stem cells, other types of stem cells, and liver resident cells including hepatocytes, cholangiocytes, and hepatic stellate cells in liver fibrosis. Exosomes have been reported to play an essential role in the inactivation or activation of hepatic stellate cells through the delivery of non‐coding RNAs and proteins. In recent years, this exosome cargo has become a research hotspot.Conclusions: Recent studies have indicated the potential therapeutic benefit of exosomes in liver fibrosis.

Background: The management of gallbladder cancer (GBC) patients with recurrence who need additional therapy or intensive follow-up remains controversial. Therefore, we aim to develop a nomogram to predict survival in GBC patients with recurrence after surgery.Methods: A total of 313 GBC patients with recurrence from our center was identified as a primary cohort, which were randomly divided into a training cohort (N = 209) and an internal validation cohort (N = 104). In addition, 105 patients from other centers were selected as an external validation cohort. Independent prognostic factors, identified by univariate and multivariable analysis, were used to construct a nomogram. The performance of this nomogram was measured using Harrell’s concordance index (C-index) and calibration curves.Results: Our nomogram was established by four factors, including time-to-recurrence, site of recurrence, CA19-9 at recurrence, and treatment of recurrence. The C-index of this nomogram in the training, internal and external validation cohort was 0.871, 0.812, and 0.754, respectively. The calibration curves showed an optimal agreement between nomogram prediction and actual observation. Notably, this nomogram could accurately stratify patients into different risk subgroups, which allowed more significant distinction of Kaplan-Meier curves than that of using T category. The 3-year post-recurrence survival (PRS) rates in the low-, medium-, and high-risk subgroups from the external validation cohort were 53.3, 26.2, and 4.1%, respectively.Conclusion: This nomogram provides a tool to predict 1- and 3-year PRS rates in GBC patients with recurrence after surgery.

Gallbladder cancer (GBC) is the most common form of biliary tract malignancy with a dismal prognosis. A poor outcome in patients with GBC is related to the aggressive nature of the tumor, delayed diagnosis, and a lack of reliable biomarkers and effective treatment. Therefore, early diagnosis and accurate disease assessment are crucial to prolonging the patient survival. Identification of novel prognostic and diagnostic biomarkers may help improve the early diagnostic rate and develop specific targeted treatments for patients with GBC. We herein review the novel biomarkers that may be associated with the diagnosis and prognosis in GBC and their potential clinical significance in the management of GBC.