The phone was connected, and a slightly hoarse voice came through electromagnetic waves, interspersed with a few coughs. It was already 10 p.m., and Yang Haoxian, chief physician of the Department of Thoracic Surgery at the Cancer Prevention and Control Center of Sun Yat-sen University, finished his day's surgery and drove home to have time to talk to reporters.
It was Monday, and from the faint light of the morning to the twinkling of stars, Yang Haoxian had a total of 6 surgeries. After visiting the patient after the operation, he received a text message from the patient's family, thanking him and the team for their serious efforts, and saying that he was very confident in facing the future, "tiredness was swept away", and he was relieved.
As one of the earliest thoracic surgeons in China to carry out robotic surgery, since 2018, Yang Haoxian has led the team to complete about 500 robotic thoracic surgeries.
In order to promote new technologies and serve more patients, he often rotates in succession. After completing the operation last Thursday, he went to Shenzhen overnight to guide a hospital to carry out robotic surgery, went to Dongguan to give a lecture on Saturday, and went to Huizhou on Sunday to support three lung cancer surgeries. After days of running, my throat has gradually become uncomfortable, but I have not had time to adjust it well, "I can help others and get recognition, I feel that no matter how hard it is, it is worth it." ”
▲Yang Haoxian
Dance with surgical robots
In May 2019, the American Association of Thoracic Surgeons (STS) Robotic Surgery Symposium hosted a robotic thoracic surgery simulation surgery competition, where more than 40 young experts from around the world competed.
The robot used in the competition is the world's most advanced fourth-generation robotic surgical system, which is already a mainstream product in the United States, but it is still in its infancy on the mainland. Can Yang Haoxian do it?
The answer is: YES!
"99.7 points, first place!" After fierce competition, the world leader in robotic surgery, Professor Abbas E of Brown University and I. Professor Sarkaria jointly announced that Yang Haoxian was the "World Champion" and together presented him with a certificate of championship.
On the international stage, the Chinese surgeons were shown, the applause was thunderous, and the flowers were clustered, but Yang Haoxian was very sober. Looking back 25 years ago, this young expert who came out of the small town of Jimo in Qingdao, Shandong, with a history of more than 1,400 years, said that he decided to study medicine because "being a doctor is very specific" and "I didn't have a big vision at that time, but I just felt that compared with other professions, I knew what doctors could do." ”
With such a real idea, in 1994, Yang Haoxian was admitted to Sun Yat-sen Medical University and was assigned to the All England Class of Clinical Medicine. From his hometown of Qingdao to Guangzhou, the train takes more than 50 hours to drive, starting from the Yellow Sea, crossing the Yellow River and the Yangtze River, all the way to the South China Sea, in a completely unfamiliar place, starting a novel life journey.
On campus, Yang Haoxian studied diligently and achieved excellent results, and decided to study for graduate school when he was close to undergraduate. A young man in his early 20s, who dared to fight and dare to break through, thought that surgery was the most challenging, and decided to deepen his work in this regard. In order to determine which department to apply for, he specially ran to the Cancer Center of Sun Yat-sen University to see the experts on the bulletin board, "I saw that the top of the line was a thoracic surgery specialist, so I applied for the graduate school of thoracic surgery, under the guidance of Professor Wu Yilong, a well-known lung cancer expert." ”
Yang Haoxian is a master's and doctoral student, and when he graduated with a doctorate, he was recruited to work in Shanghai Pulmonary Hospital. Founded in 1953, this hospital is one of the leaders in the field of thoracic surgery in mainland China, with the characteristics of common diseases, multiple diseases and difficult and critical diseases in the respiratory system, and the number of surgeries is among the best in China. Here, Yang Haoxian focused on lung diseases and laid a solid clinical foundation. Four years later, he returned to Guangzhou to do postdoctoral research at the Cancer Prevention and Control Center of Sun Yat-sen University, under the supervision of Professor Fu Jianhua, a well-known thoracic surgery expert.
"Entering a new era, I don't want to simply repeat the path of my predecessors." In the long time of clinical practice, Yang Haoxian has become more and more aware that ordinary minimally invasive surgery has reached a bottleneck, in order to break through must rely on the power of scientific and technological progress, in 2010, he was determined to learn more advanced technology on the other side of the Atlantic.
▲In May 2019, Yang Haoxian won the championship in the fourth-generation robot thoracic surgery simulation surgery competition
The process did not go smoothly, and initially he applied for a study abroad scholarship, but the approval time was long. Later, the National Scholarship Fund Young Teachers Study Abroad Training Program selected talents in colleges and universities, requiring applicants to submit overseas research plans, Yang Haoxian's topic is related to robotic lung cancer surgery, an international frontier field that represents the development direction of lung cancer surgery.
The application was approved in 2013, and a year later, Yang Haoxian crossed the ocean and entered the world's oncology hall and senior talent training base - Memorial Sloan Kettering Cancer Center in the United States.
As soon as he entered, Yang Haoxian was shocked, and in front of him were 18 well-equipped operating rooms, 7 of which were already equipped with robots. The surgeon does not have to contact the patient directly, or even wear a surgical gown, but sits in front of the operating table and accurately passes the operation instructions to the robot through the sensor, and the robotic arm can perform the operation accurately.
"This study abroad is important to my career." Since then, Yang Haoxian said, he has been training in the simulation laboratory almost every day, while pondering the research related to machine lung cancer surgery.
At that time, the United States had developed a lot in robotic surgery technology, but there was a lack of convincing data in the field of long-term survival of patients. He did a lot of literature research, wrote a review of papers, and proposed scientific ideas to Professor David R. Jones, director of thoracic surgery at the Cancer Center, and Professor Bernard J. Park, an authority on robotic lung cancer surgery, which were affirmed and strongly supported by both of them.
"Memorial Sloan Kettering Cancer Center is one of the first medical centers in the world to perform robotic surgery, and there is a long follow-up data, on which I summarize a large sample." Yang Haoxian said that he carefully designed the research plan, compared and analyzed the three surgical modes of robot, traditional thoracoscopy and open chest, and the results of the one-factor analysis found that compared with traditional thoracoscopic lung cancer surgery, robot lung cancer surgery can reduce the recurrence of patients' diseases, and the 5-year disease-free survival rate has increased by 7%. "Although this result needs to be confirmed by a multicenter prospective randomized controlled study, it is enough to attract attention to robotic lung cancer surgery."
"We further analyzed that one of the reasons is that ordinary thoracoscopic surgery has certain limitations due to instrumental limitations, which is an important reason for recurrent metastasis, and cleaning will be more thorough with the blessing of robots." Yang Haoxian introduced. After returning to China in 2015, he continued this research, and in 2017, the results were published in the world's most authoritative journal in the field of surgery, "Yearbook of Surgery", which became the first study in the world to systematically compare the long-term efficacy of robots, general thoracoscopy and open chest surgery, and obtained encouraging data on the long-term efficacy of robotic lung cancer surgery.
Regrettably, however, this was a retrospective study using historical sources. In order to make up for it, and in order to achieve transcendence, since 2020, with the funding of Sun Yat-sen University, Yang Haoxian has led more than 20 hospitals in Shanghai, Beijing, Chengdu, Shandong, Sichuan and other provinces and cities, planning to compare the long-term efficacy of robotic surgery and general thoracoscopic surgery in early lung cancer through prospective randomized controlled studies of more than 1,000 patients.
"More than 230 cases have been recorded so far, and the target is expected to be achieved within three years." Yang Haoxian is full of expectations, this is the world's first multi-center prospective randomized controlled study in this field, "We aim at the international frontier, after completion, China's robotic lung cancer surgery will achieve the transformation from catching the tide, getting the tide to leading the tide." ”
Make surgery easier
When Yang Haoxian returned to China, robotic surgery just entered a stage of rapid development, but the equipment was expensive and the number was limited, and thoracoscopic surgery was still the most widely used minimally invasive surgical technique for lung cancer.
"Is there room for improvement?" Yang Haoxian has been thinking about it and decided to open up single-hole thoracoscopic lung cancer surgery. Soon, this young doctor chasing robotic surgery surprised many people.
In June 2017, Yang Haoxian won the first prize in the South China Division of the Pneumonomy Group in the 2017 Outstanding Young Physician Surgery Competition in Thoracic Surgery, and a month later, won the national championship. In September of the same year, he set another record: a single-hole thoracoscopic lung cancer radical resection incision was only 3 centimeters, the surgical bleeding did not exceed 50 ml, and the patient could get out of bed the next day to walk, known as "minimally invasive within minimally invasive".
"My hands are typical of surgeons' hands." Yang Haoxian said. His hands were small, soft and powerful. In order to increase the flexibility of his hands, he practiced on the simulator every day, and deliberately used his left hand to play basketball and badminton.
In June 2018, a lung cancer patient learned from the Internet that Yang Haoxian was doing robotic surgery research. Yang Haoxian also feels that the time is ripe for his own robot surgery.
In order to ensure that nothing goes wrong, he made a fine design and repeatedly deduced it with his assistant. Chinese is different from the American human body, if the way of training abroad is unchanged, the robotic arms may interfere with each other in the patient's body. To this end, he injected gases such as carbon dioxide into the patient's body, used air pressure to expand the chest cavity, and changed the position of the punch, successfully using a robotic arm to remove the patient's lung lesions.
From the beginning of this operation, Yang Haoxian insisted on making clear videos for research, which made him progress rapidly. A thoracic surgery online platform has a highly clicked instructional video, which is actually his third surgery.
"Compared with traditional thoracoscopic surgery, the robot has a high-definition three-dimensional field of view, which can zoom in by 10 to 40 times and clearly see the structure of human tissue. The robot arm is also more flexible, can turn 360 ° and move forward, right, left and right, up and down and other 7 degrees of freedom, making the operation more convenient. Yang Haoxian said that many difficult surgeries can also be easily achieved.
▲ Yang Haoxian (third from left) instructs experts in the outer courtyard to carry out robotic surgery
In August 2020, 61-year-old Chen Bo came to the CUHK Cancer Center to find Yang Haoxian. He had an 11.6 cm tumor on his chest, in a very sharp position, extending along the upper mediastinum from the chest cavity to the neck. Thoracoscopic surgery is extremely difficult, while traditional open surgery requires cutting in from the right side of the body, splitting the entire sternum, and exposing the chest cavity to the neck to peel off the tumor close to the thyroid gland. Such surgeries are too risky, and patients are likely to not be able to get off the operating table; even if successful, postoperative recovery will be very slow.
Robotic surgery mitigates the risk. Yang Haoxian skillfully operated the robot, flexibly rotating in Chen Bo's body, from the chest cavity to the neck, peeling off the tumor bit by bit. After complete resection, the tumor tissue is placed into a special specimen bag by the robot arm, and then a diversion is inserted into the tumor body, which sucks out the fluid in the cyst and then removes it completely. After the operation, Chen Bo only left a few 8 mm small holes in his body, and he was able to get out of bed after 1 day.
In addition to high difficulty, robotic surgery can achieve refined operation, which has more prominent advantages in improving the quality of life of patients after surgery.
Through the delicate surgical design, Yang Haoxian made a small hole in the gap between the muscles on Uncle Li's body and put the robot arm into it, which not only completely removed the tumor, but also avoided muscle damage. Soon after the operation, Uncle Li returned to his beloved badminton court.
There is also a female mediastinal tumor patient who pays great attention to the image and does not want to have obvious trauma on the body. She has also done breast aesthetics, because the tumor is so large that ordinary laparoscopic surgery cannot complete minimally invasive resection. Yang Haoxian customized a personalized surgical plan for her, punching small holes from the edge of the chest and other places that the bra can cover, and recovering after the operation, the traces of the small holes are almost imperceptible.
"In the past, medical technology was backward, and lung cancer patients only wanted to survive. With the advancement of technology, the tumor cure rate is getting higher and higher, and there are higher requirements for the quality of life after surgery. Yang Haoxian found in the clinic that each patient has different requirements for the incision, and later he thought that he simply launched a "private customization" service.
The first person to experience it was a female patient in her 40s. She loves to swim and is afraid of leaving obvious scars on her body. Yang Haoxian only told her that there will be 3 incisions in the operation, and you can be where you want. The patient did not believe it, yang Haoxian asked his daughter to take her to the toilet and draw the desired hole on the body.
After the patient came out, Yang Haoxian was also surprised, because the three holes drawn by the mother and daughter coincided with the height he expected: one under the right areola and one in the place where the hand was hanging on the side of the outer side of the breast. There was only one, the mother and daughter, painted in front of the sternum in front of them, which did not conform to medical principles and were adjusted by Yang Haoxian to the armpits.
"A lot of times, doctors and patients think very much the same thing." Yang Haoxian said. Later, with regard to the location of the incision, he directly handed over the choice to the patient first, and then further helped to correct the patient's idea that did not conform to medical principles, taking an important step towards individualized surgery.
In addition to achieving "private customization", robots also have a major advantage, that is, they can implement telemedicine. Yang Haoxian has a wish, hoping that one day I can use domestic robots to carry out remote surgery, "I am in Guangzhou, the patient is in Xinjiang or other regions, there is equipment, there is a network, I can do surgery, avoiding long-distance travel of patients." ”
Do the surgeon with temperature
It's a tense moment, and it's a normal moment. In the operating room, the shadowless light is lit, and the surgical robot waits obediently. The nurse towed the robot to the operating table, and the assistant extended its three mechanical operating arms and one endoscopic arm from the pre-open opening into the patient's chest cavity. Everything was ready, Yang Haoxian sat firmly in front of the control table, according to the pre-designed plan, using both hands and feet, skillfully commanding the machine, naked eye 3D plus a magnified field of vision 10 times, the lymph nodes and nerves in the chest cavity were clearly visible.
The operating room and the operating room are separated by a transparent glass wall. The requirements for sterility in the operation room are not so high, which is convenient for doctors to observe and learn, and the "zero distance" directly hits every detail of the surgical operation, and the situation in the operating room can also be seen. There is also a large LCD display in the operating room, which shows Yang Haoxian's surgical field of vision in real time.
Lying on the operating table is an old smoker in his 70s, and the picture shows that his lungs have been stained with a lot of "smoke color". PET-CT diagnosed him with lung cancer, some practices are to remove everything in the lobe of the lung, but Yang Haoxian is not too troublesome, insists on removing the lesion first, waiting for the pathological diagnosis, so as not to blindly expand the operation, causing unnecessary excessive trauma, and has been waiting in the operation room. Half an hour turned out, not cancer. Before the knife had actually started, the operation was over.
"Robots make surgery more precise, and I will do everything I can to avoid subjective mistakes that cause pain to patients, never prescribe medicines that should not be taken, and never do surgeries that should not be done." Yang Haoxian said. In the eyes of many patients, he is a strange surgeon who often advises people not to operate.
Aunt Feng is a hunan native, last year's physical examination found that there are ground glass nodules in the lungs, she is not at ease, after being introduced to Guangzhou to seek medical treatment, want to do minimally invasive surgery to remove. "Judging from the results of the examination, your nodule has not enlarged, and regular follow-up is enough, without surgery." After listening to Yang Haoxian's diagnosis, she was somewhat surprised.
▲Yang Haoxian patiently consulted
Yang Haoxian has seen too many similar patients and understands their doubts and worries, so he tirelessly explains and dissuades them. He said that most of the outpatients are ground glass nodules, which can be divided into three types of situations, one is to confirm lung cancer, the condition develops quickly, and surgery is needed as soon as possible; the second is to suspect lung cancer, but the lesion is small, the degree of malignancy is estimated to be low, the development is slow, if it does not increase, it does not worsen, you can not do surgery, worsen and then do surgery, the effect is also very good; the third is basically confirmed to be benign, check CT every few years on the line.
Doctors need to put more energy into the second kind, Yang Haoxian has seen many patients because of this anxiety, can not sleep, can not eat.
A patient in Dongguan was diagnosed with a ground glass nodule, often in worry, and sometimes even wanted to jump off the building for a hundred years. After Yang Haoxian learned about it, he deliberately drove to the patient's house for tea and chatted on the weekend, and advised him: "If you really want to do surgery, I can help you do it." But as a professional doctor, I advise you not to have surgery. ”
A top surgeon specifically came to persuade himself not to have surgery? The patient thought about it, this was a scene that had never been seen before, and the big stone that had been pressing on the heart was also put down.
There are also times of helplessness. A patient in his 30s had multiple ground glass nodules in his lungs, because his family was not at ease, did not listen to Yang Haoxian's persuasion, went to other hospitals for surgery, and there was shortness of breath and shortness of breath after surgery.
When encountering patients who need special attention during the outpatient clinic, Yang Haoxian will record them and follow up regularly. He has an Excel document in his computer, recording the condition, family history, medication history, risk factors, mental condition, etc. of hundreds of patients, nearly 50 children, and the content is richer than the medical records. These people have taken his phone calls or visited him, and many of them have become friends with him.
"The lungs are respiratory organs, and it takes a slice of the lungs to cut off the lesion, even if the lesion is small, the respiratory function will decline." Yang Haoxian said. Even if surgery is inevitable, he hopes to do a little more for the patient, such as avoiding the pain of unnecessary excessive chemotherapy.
In August 2021, Yang Haoxian, led by pathologist Lin Suhui, internal medicine expert Hou Xue and others, together with the team of Memorial Sloan Kettering Cancer Center and Guangdong Provincial People's Hospital, published the latest research results in the international authoritative journal of thoracic medicine, KISS: non-small cell lung cancer (PL1) with tumors under 3 cm that break through the visceral pleural elastic fiber layer but do not invade the pleural surface should be classified as T1 in T stage instead of T2.
The four-year study was a boon for patients with early-stage lung cancer — patients with stage I lung cancer with PL1 did not need postoperative adjuvant chemotherapy without lymph nodes and distant metastases, thus avoiding the side effects and financial burden of overtreatment.
Yang Haoxian said that he hopes to achieve the ultimate in robotic surgery, achieve advanced concept and technological leadership, and treat more patients with smaller trauma. At the same time, he also hopes to call for and promote the reduction of excessive diagnosis and over-treatment of tiny nodules in the lungs, and bring more humanistic care to patients, "To be a doctor, you can't only be a physical doctor who can operate, but also a psychologist with temperature." ”
Lead Writer | Song Bingjun
Reporter | Zeng Jianping
Edit | Liang Mu, Fang Yang, Su Haining, editor| Zhang Xiuli
Source | This article was first published in the magazine "The Beginning of Man" and may not be reproduced without authorization
Produced by Guangdong Health Online All Media Team