Clinical Decision Making for Improving Prognosis

196 Pages·2022·2.381 MB·English

by  Rong Liu

Clinical Decision
Making for
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Rong Liu
Editor
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Clinical Decision Making
for Improving Prognosis
Rong Liu
Editor
Clinical Decision Making
for Improving Prognosis
Editor
Rong Liu
Hepatopancreatobiliary Surgery
Chinese PLA General Hospital
Beijing, China
ISBN 978-981-19-2951-9 ISBN 978-981-19-2952-6 (eBook)
https://doi.org/10.1007/978-981-19-2952-6
Jointly published with Science Press
The print edition is not for sale in China (Mainland). Customers from China (Mainland) please order the
print book from: Science Press.
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Abstract: Rapid advances of big data and
artificial intelligence (AI) techniques have
pushed the envelope of traditional surgery to
intelligent surgery, which revolutionizes the
traditional medicine model dominated by the
experiences of interveners and evidence-
based medicine. Intelligent surgery requires
to judiciously integrate the clinical
experience of interveners and medical
evidence with the new AI techniques, so as to
achieve the best therapeutic effect for patients
through effective disease risk control. This
book puts forward a new theory of prognostic
control surgery in the long-term clinical
practice of hepato-pancreato-biliary surgery.
Our theory takes the optimal prognosis of
patients as the goal, and pre-controls the
disease risk through the best combination of
the optimal intervener, intervention methods,
and intervention timing to achieve the
maximum clinical benefits for patients with
minimal medical trauma. This theory also
takes full advantage of information
technologies such as neural networks, deep
learning, big data, and imaging system and
uses high-dimensional decision-making to
replace the traditional two-dimensional
decision-making tree model.
A main technical challenge in the theory is
how to effectively exploit the AI techniques to
improve the work efficiency of large
hospitals, enhance the service level of
primary medical care, and improve the
diagnosis, prediction, and treatment of
diseases. Prognostic control surgery
advocates the exploitation of emerging
information technology methods, such as
medical image recognition and prediction,
3D reconstruction-based surgical planning,
intraoperative navigation, and remote
intelligent robotic surgical system, to
promote the rapid and balanced surgical
diagnosis and treatment.
Guided by our theory of prognosis control
surgery, our team successfully established
minimally invasive anatomic hepatectomy,
individualized pancreatic surgical
approaches, modular hepatectomy, single-
layer continuous suture of
pancreaticojejunostomy, and end-to-end
pancreatic anastomosis. This book also
provides details of four core surgical
strategies proposed in our prognosis control
surgery, namely, blood control technique,
surgical approach selection, resection
technique, and reconstruction technique, by
which to achieve minimally invasive surgery
regularization and complex surgery
simplification.
Foreword
Recently, we have lived in a dramatically changing world. In our surgical field, there
have been many innovations including robotic surgery, image-guided surgery, and
high information technologies such as artificial intelligence (AI).
Just a few years ago, there were no legions of deep learning scientists developing
intelligent products and services at major companies and startups. Recently, deep
learning has taken the world by surprise, driving rapid progress in fields as diverse
as computer vision, natural language processing, automatic speech recognition,
reinforcement learning, and statistical modeling. With these advances in hand, we
can now build cars that drive themselves, smart reply systems, wearable medical
appliances, and so on. However, surgeons usually had no idea how machine learning
could be helpful in surgery.
Professor Rong Liu’s group proposes prognostic control surgery based on long-
term and tremendous experiences on hepato-pancreato-biliary surgery.
They recommend that pre-controls the disease risk through the best combination
of the optimal intervener, intervention methods, and timing to achieve the maximum
clinical benefits from surgical stress. Those theories take full advantage of informa-
tion technologies such as neural networks, deep learning, big data, and imaging
system to replace traditional decision-making.
This book is designed to achieve minimally invasive surgery regularization and
complex surgery simplification through prognosis control as well as standardization
of surgical techniques. I hope this textbook would be loved by many surgeons to
broaden their knowledge and safety on HBP surgery.
Department of Surgery Jin-Young Jang
Seoul National University Hospital
Seoul, Korea
27 April 2019
vii
Foreword
With the gradual application of information technology represented by the Internet,
big data, and artificial intelligence, surgery has entered the era of intelligent surgery,
and 3D reconstruction, intraoperative navigation, and robotic surgery have promoted
the development of minimally invasive surgery. How to change the traditional diagno-
sis and treatment concept of doctors, how to make full use of advanced intelligent
surgical tools, and how to better serve patients are the urgent issues that need to be
solved at present.
As a pioneer of minimally invasive hepatobiliary and pancreatic surgery in China
and abroad, Professor Rong Liu is not only a world leader in the number of robotic
hepatobiliary and pancreatic surgeries but also has unique insights and innovations
in surgical techniques and concepts. What is even more valuable is that Professor
Rong Liu is not satisfied with his profound attainments in the field of surgery, but
from the perspective of adapting to the rapid development of medical technology
and the increasing medical needs of patients, he has proposed the theory of prognos-
tic control surgery in his long-term surgical clinical practice.
Starting from the theory of prognosis control, “Prognosis Control Surgery” divides
the surgical process into four major elements: disease risk, interventionist, intervention
means, and intervention timing and elaborates them respectively. On this basis, four
core strategies of surgery are summarized: blood control, access, resection, and recon-
struction, emphasizing the maximum benefit to patients with minimal damage. This
work is highly innovative and practical, overcoming the limitations of the traditional
surgical medical model, and has important reference and learning value especially in
the current rapid interactive development of information technology and surgery.
C hinese Academy of Sciences Wan Yee Lau
Beijing, China
Lee Woo Sing College
The Chinese University of Hong Kong
Shatin, Hong Kong
16 April 2019
ix
Foreword
Surgery has evolved significantly over the last few centuries changing from seem-
ingly barbaric procedures to highly specialized procedures. There is an exponential
growth in the number of complex operations being performed worldwide on a day-
to- day basis. One of the main reasons for success is the ever-expanding availability
of newer technologies. Having said this, we should admit the fact that we are still
far from perfection, and there is scope for further refining the management strate-
gies to achieve optimum results in our patients.
The powerful evolving technologies like artificial intelligence (AI), big data, and
three-dimensional (3D) printing techniques are likely to have a significant impact
on the future of medicine. The concept of “Prognosis Control Surgery” by Prof.
Rong Liu is new and exciting, where the strategy would be to exploit artificial intel-
ligence at every step of patient care from risk elimination to palliation. It has the
potential to revolutionize the field of surgery just the way ether anesthesia revolu-
tionized this field in the last century.
This book mainly focuses on the management of hepato-pancreato-biliary disor-
ders, utilizing technologies like neural networks, deep learning, big data, and imag-
ing system. Authors will also exploit methods as medical image recognition and
prediction, a 3D reconstruction-based surgical planning, intraoperative navigation,
and remote intelligent robotic surgical system to promote the rapid and balanced
surgical diagnosis and treatment. This book is based on four core operational strate-
gies, namely, blood control technique, surgical approach selection, resection tech-
nique, and reconstruction technique, by which to achieve minimally invasive surgery
regularization and complex surgery simplification.
I hope this book by Prof. Rong Liu will help to advance the surgical sciences
towards more customized and safe healthcare.
Best Wishes,
Gastrointestinal Surgery C. Palanivelu
GEM Hospital & Research Centre
Coimbatore, Tamil Nadu, India
21 May 2019
xi
Content Introduction
This book is divided into six chapters; the first chapter is Introduction: a total of five
sections. Section 1 proposes the basic concept of prognosis control surgery and four
elements of prognosis control surgery, and analyzes the ultimate goal, realization
means, and realization process of prognosis control surgery. Sections 2 to 5 are
summarized in terms of the optimization of the four elements of disease risk, inter-
vention providers, intervention means, and intervention timing, respectively.
Chapter 2 is Surgical Risk Management: there are five sections. Section 1 reviews
the brief history of surgical development and helps to recognize the surgical risks
that have occurred in history, been solved, and have not been solved. Section 2 clari-
fies the theory of surgical risk control and details the composition and framework of
surgical risk control system. From Section 3 to Section 5, according to the logical
sequence of surgical risk pre-control system, the risk management is introduced in
detail from three aspects: risk identification, risk evaluation, and risk intervention.
Chapter 3 is Decision-Making Process for Interveners: there are five sections.
Section 1 details the classification, characteristics, and influencing factors of clini-
cal decision-making. Section 2 focuses on the process from diagnostic decision-
making to therapeutic decision-making, as well as the quality needed to cultivate
clinical thinking. Section 3 introduces how to use evidence-based medicine in
decision- making and its important impact on intervention provider decision- making.
Section 4 introduces the MDT model into intervention provider decision-making,
extends individual intervention provider decision-making to the level of multidisci-
plinary consultation, and demonstrates the importance of MDT through specific
clinical cases.
Chapter 4 is Optimization of Interventions: a total of four sections. Section 1
details the characteristics, classification, and clinical significance of intervention
optimization from the perspective of damage control with specific examples. Section
2 focuses on the driving effect of theoretical innovation on the optimization of inter-
vention means. Section 3 introduces how to simplify and standardize the diagnosis
and treatment process through the pathing, patterning, and modularization of inter-
vention means, which is conducive to improving the overall level of intervention.
Section 4 introduces in detail how to optimize the means of intervention and the
effective allocation of medical resources from the perspective of cost-effectiveness
optimization. Section 5 closely follows the pace of scientific and technological
development, focuses on the development status of artificial intelligence in the
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