Recently, when I communicated with some colleagues who recently carried out laparoscopic radical gastrectomy for gastrointestinal cancer, a common problem was mentioned: it was easy to watch the surgical videos of many experts, but it was difficult to get started.  Even for patients who are thin, it's theoretically very smooth to do, and the image becomes bloody after only a few steps.  It looks good, but it doesn’t work.  In this regard, I would like to share with you some of my own views. There are about eight core factors in this regard.  

1.  It is mainly about operating experience and number of operating cases

In general, laparoscopic surgery is based on 50 procedures, and those 50 procedures are based on good open surgery experience.  Usually, 50 cases of skilled open operation are far from enough.  For young doctors, according to the traditional learning model, it is almost impossible to have more than 100+ opportunities for solo surgery without a few years, more than ten years, or even 20 or 30 years of "hibernation".  If you want to shorten the learning curve, you have to take advantage of all the mature experience you can draw on, especially the systematic theory of surgery.  To fully digest and absorb these surgical experience and surgical theory into their own knowledge, so as to get twice the result with half the effort.  

2. Accuracy of local anatomical mastery

More than ten years ago, Professor Han Guang-senonce talked about the nine levels of anatomy he summarized, which discussed the nine levels of systematic anatomy and local anatomy, three-dimensional anatomy, sensory anatomy, control anatomy, reconstruction anatomy, functional anatomy, effect anatomy, imaging anatomy, membrane anatomy and transmembrane anatomy.  Local anatomy is classified as basic anatomy, and young doctors should learn relevant local anatomy knowledge repeatedly after entering clinical work.  When you do an inguinal hernia you learn the anatomy of the groin over and over again, when you do gallbladder you learn the anatomy of the hilum over and over again, when you do gastrointestinal surgery you learn the anatomy of the gastrointestinal tract over and over again.  But frustratingly, the anatomy of the gastrointestinal tract is much more complex than that of the groin and hilum.  

3.  The cooperation of surgical team

The cooperation of the surgical team is also a very important factor. I remember that a famous expert in China once said that when he was young, in order to make the operation easier and smoother for the teacher to operate on the operating table.  It's often a night or even a few days in advance to go over every detail of the operation and optimize it.  After the operation, the coordination skills should be improved repeatedly.