Jianping Zeng

Continuous theoretical and technological progress in the face of increasing expectations for quality health care has transformed the surgical paradigm. The authors systematically review these historical trends and propose the novel paradigm of "precision surgery," featuring certainty-based practice to ensure the best result for each patient with multiobjective optimization of therapeutic effectiveness, surgical safety, and minimal invasiveness. The main characteristics of precision surgery may be summarized as determinacy, predictability, controllability, integration, standardization, and individualization. The strategy of precision in liver surgery is to seek a balance of maximizing the removal of the target lesion, while maximizing the functional liver remnant and minimizing surgical invasiveness. In this article, the authors demonstrate the application of precision approaches in specific settings in complex liver surgery. They propose that the concept of precision surgery should be considered for wider application in liver surgery and other fields as a step toward the ultimate goal of perfect surgery.

Abstract Conventional tissue adhesives face challenges for hemostasis and tissue regeneration in large‐scaled hemorrhage and capillary hypobaric bleeding due to weak adhesion, and inability to degrade at specific sites. Herein, convenient and injectable poly(ethylene glycol) (PEG)‐based adhesives are developed to address the issues for liver hemostasis. The PEG‐bioadhesives are composed of tetra‐armed PEG succinimide glutarate (PEG‐SG), tetra‐armed PEG amine (PEG‐NH 2 ), and tri‐lysine. By mixing the components, the PEG‐bioadhesives can be rapidly formulated for use of liver bleeding closure in hepatectomy. The PEG‐bioadhesives also possess mechanical compliance to native tissues (elastic modulus ≈40 kPa) and tough tissue adhesion (≈28 kPa), which enables sufficient adhering to the injured tissues and promotes liver regeneration with the PEG‐bioadhesive degradation. In both rats of liver injury and pigs of large‐scaled hepatic hemorrhage, the PEG‐bioadhesives show effective hemostasis with superior blood loss than conventional tissue adhesives. Due to biocompatibility and degradability, the PEG‐bioadhesive is advantageous for liver regeneration, while commercial adhesives (e.g., N ‐octyl cyanoacrylate) display adhesion failure and limited liver reconstructions. These PEG‐bioadhesive components are FDA‐approved, and demonstrate excellent adhesion to various tissues not only for liver hemostasis, it is a promising candidate in biomedical translations and clinical applications.