Wang Xuedong： In Xizang, fighting the plateau with precision medicine.

Cctv news(Reporter/Chen Shiwen correspondent/Han Dongye): How long is a year? The 3-year-old Dawa went to school and gradually forgot her father’s appearance; Erwa, who is half a year old, babbles and learns to call her father for the wedding photos. And he, tanned by the light of the Qinghai-Tibet Plateau, lost a circle, but succeeded in expanding the year to be thick and full. He is Wang Xuedong, deputy chief physician of the Department of Hepatobiliary and Pancreatic Surgery, Chang Gung Memorial Hospital, Tsinghua, Tsinghua University, and the first supporting doctor in the general surgery department of Lhasa People’s Hospital, Xizang in recent five years. In the summer of 2020, he came to Lhasa as a Tibetan aid doctor and began his dream trip to spread the concept and technology of precision surgery on the Qinghai-Tibet Plateau.

Wang Xuedong is in Lhasa, Xizang.

"I made this decision without thinking too much."

When careful Wang Xuedong was still working in Beijing, he found that there were many patients from Xizang in the hospital, but unfortunately some diseases dragged on late. This made him very emotional. If there is a way to find it early and treat it early, the treatment effect will be better.

Wang Xuedong’s teacher, Academician Dong Jiahong of China Academy of Engineering, is not only the founder and advocate of the concept of precision surgery, but also goes to Xizang, Qinghai, Xinjiang and other remote areas for screening, free clinic and operation of liver hydatid disease every year. Probably because of what I heard, the desire to participate in the treatment of local patients took root in Wang Xuedong’s heart.

Beijing’s "group-based" medical aid to Tibet began after the Sixth Central Xizang Work Forum in 2015. Due to the development needs of different departments in local hospitals in Xizang, and the local general surgery has a certain technical foundation, five years later, in 2020, general surgery finally got a chance to help. It took less than a week from the decision to sign up for Tibet aid to the departure. Wang Xuedong’s "efficiency" is amazing for a one-year task that spans more than half of China and is thousands of meters above sea level.

The outbreak of the epidemic in 2020 made all the work start relatively late. In late July, Wang Xuedong received a notice to leave at the end of that month just after signing up. Because the epidemic is severe, everyone needs unified management. "The day after tomorrow, about two days later."

As soon as Wang Xuedong got home, he quickly packed his things. He and his wife counted the time and left in less than 48 hours. The combined age of the two children is less than four years old, which is the time when the family needs manpower most. Wang Xuedong recalled that his wife gave him unlimited support and took the initiative to provoke the burden of the family, so that he had no worries about this "journey".

The mission of aiding Tibet is Lhasa People’s Hospital, which is more than 3,700 meters above sea level. Not only is there no oxygen, but the air pressure is very low and the climate is extremely dry. Even so, Wang Xuedong boarded the flight to Xizang without much thought. Wang Xuedong remembers, "From getting off the plane to walking out of the airport, I took two breaks with heavy luggage." When he is physically active or talking too much, he will easily gasp and feel flustered in severe cases. Although he is getting used to it now, Wang Xuedong will obviously feel more tired after each operation.

The picture shows Dong Jiahong (third from left) and Wang Xuedong (first from right) teaching rounds in Lhasa People’s Hospital.

The vacuum-packed food he brought from Beijing is all bulging, because the air pressure here is only half that of the plain area. Because the air pressure is too low, the human body becomes difficult to sleep at night. If you forget to take sleeping pills at night, you will naturally wake up once every hour. The unit distributed more than one humidifier, but when you get up in the morning, blood clots often condense in your nose. For Wang Xuedong, these small difficulties are insignificant in the face of saving lives.

After the first two weeks of training, department investigation and stubble handover, Wang Xuedong learned that the local general surgery technology can cover most common and frequently-occurring diseases, such as cholecystitis, appendicitis and simple treatment of liver hydatid disease. However, compared with large and medium-sized hospitals in China, there is still much room for improvement in treatment concept, surgical techniques, including clinical research and department system. In addition, many operations can’t be completed in local hospitals and need to be referred for treatment.

What I saw and heard in Lhasa made Wang Xuedong set his first goal: to improve the business he had carried out; Patients to be transferred, stay.

The concept of precision surgery: know yourself and yourself, and win every battle.

The picture shows Dr. Wang Xuedong (first from left) performing the first 4k laparoscopic choledocholithiasis operation in Xizang.

In August, 2020, Wang Xuedong led the team to carry out the first 4K laparoscopic cholecystectomy and choledocholithotomy through cystic duct in Xizang Autonomous Region. The door of minimally invasive surgery is opened here, and a variety of difficult minimally invasive operations such as large-scale liver resection, radical gastrectomy, radical colorectal cancer resection, pancreaticoduodenectomy, and endoscopic resection of gastric stromal tumors are gradually developed. Today, they have made 9 records of the first operation in Xizang Autonomous Region and 3 records of the first operation in Lhasa People’s Hospital.

In October 2020, a 4-year-old child, Solang Gray, came to the general surgery department of Lhasa People’s Hospital. Three months ago, Solang had undergone a major thoracotomy for pulmonary echinococcosis, and at that time, his liver was also diagnosed with echinococcosis. Due to many factors such as local natural environment, sanitary conditions and cultural customs, this disease is relatively high in the local area, and it is a parasitic disease that is zoonotic.

Three-dimensional surgical planning and virtual surgical resection were performed for four-year-old children before minimally invasive right hemihepatectomy

According to the abdominal image at that time, the liver hydatid in Xiao Suolang had invaded most of the right liver, and two lesions, with diameters of 11 cm and 8 cm respectively, were next to important pipelines such as hepatic portal and middle hepatic vein. When I came to the hospital again and heard that I had to have surgery again, Xiao Solang was very resistant and afraid of postoperative pain and scars.

According to Xiao Solang’s situation, open resection is simpler and safer. Although laparoscopic resection of the lesion is minimally invasive, it is difficult: the abdominal space in children is small and the lesion is huge, and it is difficult to dissect and expose the hepatic portal under endoscope, and the lesion is close to the middle hepatic vein. Accurate preoperative evaluation is needed for accurate laparoscopic resection.

Wang Xuedong said that in traditional surgery, exploration is the main surgical step, that is, after the operation, the specific surgical method is decided according to the situation found during the operation. However, this kind of "exploration" is faced with great uncertainty, and there are often many temporary problems to be solved during the operation, and it is difficult to do the preoperative preparation.

The concept of "precision surgery" actually runs through and is embodied in the whole process before and after the operation, including not only precise surgical operation, but also accurate preoperative evaluation and precise surgical planning, that is, minimizing the uncertainty of traditional surgery and achieving "know yourself and know yourself, and win every battle". Sufficient surgical information should be made clear before operation, so as to strike a balance between maximizing lesion removal, maximizing organ protection and minimizing trauma. The preoperative preparation is done, and the operation is basically half successful.

In order to eradicate liver hydatid disease, reduce trauma and shorten recovery time, Wang Xuedong contacted many parties, and finally coordinated the "three-dimensional quantitative surgery planning system" for the department, and established the "precision surgery cooperation cloud center". By importing the preoperative image data of Sauron Jr., a three-dimensional visualization model was established, and several simulated hepatectomies were carried out in the three-dimensional planning system to predict the problems in the operation and make corresponding plans.

In the end, Wang Xuedong successfully performed laparoscopic right hemihepatectomy for Xiao Suolang, and the bleeding amount was less than 200ml. Xiao Suolang was able to get out of bed on the first day after operation. The introduction of this technology has not only changed the fate of patients with liver hydatid disease and liver cancer, but also changed the status quo of surgeons in Lhasa People’s Hospital. The concept of "precision surgery" is deeply rooted in people’s hearts through continuous practice.

One-day aid to Tibet, lifelong aid to Tibet

During a ward round, Wang Xuedong learned that a child had been hospitalized for more than two weeks due to incision infection after appendectomy. When asked, he realized that it was due to the long-standing cooperation problem that emergency operations such as cholecystectomy and appendectomy were still performed by laparotomy at night and weekend. This incident woke up Wang Xuedong, who was immersed in developing surgical skills. Some old ideas and systems are becoming the "shackles" for the development of the department.

"It is not possible to fight alone, but to operate in an integrated manner; It is not enough to rely solely on technological innovation, but to reform the department and talent system; It is not enough to do clinical work alone, and clinical research should be carried out. " For such a "big move", Wang Xuedong has a clear thinking. Compared with the promotion of pure technology, the improvement of the system will have greater influence and benefit on patients and departments.

Enter the temple for a free clinic for monks in Gandan Temple.

After repeated communication, coordination and resolution at the meeting, in December 2020, with the cooperation of anesthesiology department, operating room and other departments, Wang Xuedong led the general surgery to successfully carry out emergency laparoscopic surgery at night and on weekends. By June, 2021, more than 100 cases of emergency minimally invasive cholecystectomy and appendectomy were completed in general surgery, and no incision infection was found. The average length of hospital stay decreased from 9 days to 2.7 days, and the bed turnover rate increased by nearly 60%.

Wang Xuedong realized that when technology and system are available, the concrete implementation of things can not be separated from the ideas in the mind. He thought, "If I return to Beijing, local doctors can continue to do and develop according to this concept, as long as they follow this process. Only by practicing the whole process can we have a deeper understanding and experience of the concept. " After half a year’s technical teaching, Wang Xuedong no longer needs the chief surgeon, and his disciples can gradually carry out some operations independently, such as right hemihepatectomy, fluorescent laparoscopic gallbladder/bile duct surgery, percutaneous transhepatic biliary drainage (PTBD) and transcatheter arterial chemoembolization (TACE).

Wang Xuedong established a general hospital system in general surgery, breaking the current situation that there is no general hospital in the department for 20 years, and coordinating the work of general patient admission, hospital consultation, weekend and night emergency surgery, so as to cultivate reserve talents; He divided sub-professional groups in detail, including hepatobiliary, gastrointestinal, anorectal, hernia and abdominal wall, blood vessels, intervention, etc., breaking the traditional "big pot" pattern; Five doctors were sent abroad for further study, and a sub-professional group was arranged every week to explain the clinical guide … …

In order to improve the ability of clinical research, Wang Xuedong applied for the subjects in the hospital and the autonomous region respectively for the common diseases of hepatic echinococcosis and cholecystolithiasis in Xizang, and led the department team and disciples to conduct clinical research. At present, the data of SCI papers are being collected, and Tsinghua University Publishing House has also completed the project of books on common diseases of general surgery with plateau characteristics.

Wang Xuedong said, "Even if I end my support and leave Xizang, these will continue to operate. This should be what we often say to build a medical team that we can’t take away."

After a while, Wang Xuedong’s aid to Tibet this year will come to an end. He can’t forget the experience of giving free clinics to local people in temples and villages. In those remote mountainous areas with an altitude of more than 5,000 meters, the medical needs are still urgent, and the awareness of health check-up needs to be strengthened.

After Wang Xuedong and his team came here, they found some new problems. For example, there are still many differences between the disease spectrum and disease stages here and the mainland. There are many topics worthy of further study, such as comparing the diagnosis and treatment of some diseases in different natural environments and health habits between the mainland and the plateau, and whether it is necessary to make some regional and differential treatments. It is helpful for both sides to study these.

Back in Beijing, Wang Xuedong’s aid to Tibet will not stop. The "hospital-contracted" aid work and project cooperation for the Qinghai-Tibet Plateau are all under orderly preparation. One-day aid to Tibet, lifelong aid to Tibet. As he said: "As long as it is needed here, whether I am in Xizang or Beijing, I will go all out."