Fan Ning, Hepatobiliary Surgeon, Partners with Medicine-Engineering-Informatics Alliance to Develop Precision Intelligent Surgical Devices for Liver Transplantation

As the largest solid organ in the human body, the liver weighs between 1.2 and 1.5 kilograms in average adults. During liver transplantation, a traditional incision of 40 to 50 centimeters is typically required to fully expose the surgical field and facilitate vascular reconstruction, making it one of the most extensive incisions in surgical practice.

With the development and advancement of science and technology,“Major organ transplantation and minimally invasive surgery” have become the two major development directions in liver surgery.“Minimally invasive concepts are increasingly widely applied in liver surgery, achieving more efficient therapeutic outcomes with less trauma. Meanwhile, major organ transplantation, as another key direction of development, likewise carries the hope of renewed life for countless patients.”Fan Ning, Chief Physician, Department of Liver Transplantation Surgery, Dade Road Main Campus, Guangdong Provincial Hospital of Chinese Medicineindicates.

Specifically, upper abdominal organ transplantation, particularly liver transplantation, requires a "ren" (human character)-shaped incision in the upper abdomen (involving transection of the bilateral abdominal muscle groups and partial resection of the xiphoid process), which causes significant trauma. The purpose is to fully expose the anastomotic sites of the suprahepatic vessels during donor liver implantation; however, adequate exposure remains suboptimal in some patients, especially those with large donor livers and narrow costal arches.

In contrast, minimally invasive surgery demonstrates unique visual advantages: it enables close-range, delicate maneuvers by utilizing multiple perspectives within confined spaces. For reconstruction of the suprahepatic inferior vena cava, while the lead surgeon sutures in a narrow field, the assistant can use operating rods to create more working space for suturing than is possible with manual liver retraction in open surgery. In minimally invasive procedures, all surgical personnel share the same operative view, ensuring coordinated teamwork and synchronized actions. Furthermore, patients undergoing minimally invasive surgery experience fewer wound-related complications and faster recovery.

The Application of Minimally Invasive Techniques in Liver Transplantation: Promising Prospects Yet Accompanied by Challenges:Its intricate manipulation often leads to prolonged operative time and reduced efficiency, thereby limiting its application in donor liver implantation during liver transplantation.This limitation is primarily attributed to the current difficulty of minimally invasive instruments in efficiently and safely performing total laparoscopic donor liver implantation. To achieve a breakthrough in this field, a series of technical challenges and instrument limitations must be overcome, including control of major vessels (inferior vena cava and portal vein) during the anhepatic phase, rapid insertion of the donor liver, exposure of the surgical field, injury and hemorrhage caused by rapid displacement of internal organs with difficult hemostasis, prolonged anhepatic time due to the inability to perform rapid and precise vascular anastomosis, and the inability to preserve the organ under cold conditions.

Therefore, the development of dedicated minimally invasive instruments and their ancillary devices, coupled with targeted optimization of surgical techniques, has become an urgent necessity to overcome the aforementioned bottlenecks, achieve total laparoscopic donor liver implantation, and propel another significant leap forward in liver transplantation technology.

Professor Fan told VCBeat, “There have been only two successful cases of totally laparoscopic donor liver implantation worldwide to date (both involving right lobe grafts), which were performed in South Korea in 2021. The donor liver was retrieved through a suprapubic transverse incision in the lower abdomen of the donor and implanted into the right upper quadrant of the recipient through a suprapubic transverse incision. Due to the prolonged operative time and significant blood loss, although the patients experienced rapid recovery, many experts still question the rationale of this procedure.” Currently, this field is facing a technological bottleneck. Although minimally invasive techniques have accumulated extensive experience in living donor liver retrieval and have become routine procedures at multiple medical centers both internationally and domestically, significant technical challenges remain in recipient donor liver implantation, requiring urgent breakthroughs.

For example, minimally invasive surgery typically relies on only four instrument shafts for intraoperative manipulation, whereas traditional open liver transplantation allows up to four surgeons (eight hands) to operate within the surgical field. During donor liver implantation, performing this complex task solely with instrument shafts presents numerous challenges.To this end, Professor Fan has developed specialized instruments and validated their efficacy through animal experiments, steadily advancing liver transplantation toward minimally invasive techniques. Today, complex liver transplantations can be successfully performed through a small incision just large enough to accommodate the liver, marking a significant breakthrough in the field of surgery.

More importantly, Professor Faning regards the innovation and upgrading of surgical equipment as a core component. To date, his team has established five major research directions, covering “minimally invasive surgical devices for organ transplantation,” “real-time liver surgery navigation systems and robotics,” “devices to enhance the efficiency and precision of complex hepatobiliary surgeries,” “simulation-based assessment systems and related equipment for donor liver procurement and implantation in pediatric liver transplantation,” and “AI-based image recognition of surgical specimens and intelligent grading assessment devices for tumor heterogeneity.” They have successfully secured over 30 patents.

Professor Fan revealed to VCBeat that although each liver surgery expert has their own unique approach and experience during operations, these valuable experiences have not yet been translated into patterns recognizable by machine artificial intelligence. Therefore, the team is working on converting these expert experiences into replicable and scalable surgical pathways to achieve higher precision in liver surgeries.

Meanwhile, the team also leverages innovative devices such as flexible organ surgical robots and dressing-change robots to perform tedious and delicate tasks in daily surgical practice, such as wound dressing changes for patients in hospital wards. With system development led by navigation research and algorithm experts, these robots will be able to execute tasks with greater precision, thereby reducing the workload of healthcare professionals.

To address the organ shortage in transplantation, Professor Fanning is developing an innovative liver segmentation technique. Through interdisciplinary collaboration between algorithm and imaging specialists, the team is committed to achieving digital medical segmentation of the liver, ensuring that a single donor liver can meet the needs of three recipients.

Addressing the challenges in imaging and pathological diagnosis, Professor Fan Ning pointed out that current radiomics faces a bottleneck in preoperatively predicting tumor characteristics, namely the difficulty in achieving precise correspondence between imaging findings and postoperative pathological sections. Therefore, the research team is exploring the correlation between tumor status on preoperative imaging and postoperative pathological results through engineering studies, algorithmic research, and the integration of AI technologies. This will provide a robust basis for the early diagnosis and treatment of tumors, further advancing the development of precision medicine.

Professor Fan Ning emphasized: “Although the five major research directions are independent, they are closely interconnected. In particular, the gradual maturation of real-time navigation technology for liver surgery can drive progress in other areas, providing support for the overall advancement of precision liver surgery.。”

Discussing the original intention behind the translation of scientific achievements, Professor Fan Ning candidly stated, "As a surgeon, I have always regarded the transformation of technological achievements into practical applications as a crucial mission. I am eager to leverage advanced technologies to impart the exquisite surgical skills and standardized procedures of expert surgeons to more young doctors, thereby promoting the sustained development of the medical profession."

To achieve this goal, Professor Faning took the lead in assembling a surgical expert team comprising seven chief physicians and more than ten young and middle-aged attending physicians, and formed a medical-engineering-informatics expert alliance with South China University of Technology and leading industry enterprises. This alliance not only ensures that research closely aligns with actual clinical needs but also defines research directions for scientists, engineers, and experts in the field of artificial intelligence.

In 2024, the team successfully won the bid for the Engineering Research Center project issued by the Guangdong Provincial Development and Reform Commission, and on this basis, is preparing to establish a provincial-level technology transfer platform—Guangdong Provincial Engineering Research Center for Precision Intelligent Surgical Equipment

In terms of industry chain integration, Fan Ning’s team has also demonstrated outstanding performance. They successfully brought together multiple innovative enterprises from Guangzhou, Shenzhen, Foshan, Suzhou, and other regions, including leading companies specializing in surgical magnetic navigation robotics. By spearheading the inclusion of enterprises from Guangdong (Guangzhou, Shenzhen), Zhejiang, Jiangsu, and other provinces into the alliance, they have accelerated the industrialization of the project and injected new growth drivers into local economic development.

Professor Fan stated that this represents an innovative translational model driven by multi-team collaboration. The coordination among different teams primarily manifests in three aspects: first, establishing an alliance of expert teams to build a robust technical framework, ensuring that the navigation system precisely meets current clinical needs; second, addressing practical challenges encountered by enterprises during production through timely and in-depth communication with the expert team to jointly identify solutions; and third, initiating the involvement of a dedicated project team at a certain stage of implementation to conduct a comprehensive evaluation and introduce investment firms, thereby charting a viable path for the system’s operation and commercialization.

Chen Yiqun, Partner at Shangjun Investment, revealed to VCBeat thatIn the future, Shangjun will also support Director Fan Ning’s team in achieving technology transfer and commercialization through brand building and investment and financing assistance.

It is reported that in 2024, the team collaborated with multiple enterprises to advance the “Research on the Application of Domestically Produced Separable Ultrasonic Scalpels in Minimally Invasive Surgery.” As a key partner, Mindray has provided financial support for this research through a provincial-enterprise joint project with the Guangdong Provincial Department of Science and Technology.

Professor Fan stated that this is a promising start, and the team is actively considering bundling the relevant patents into a technology package to establish in-depth collaborations with more enterprises through licensing or co-incubation, thereby jointly advancing the industrialization of the technology.

Looking ahead, the research team will launch several key initiatives in 2025.In the field of surgical navigation robotics, a prototype will be launched to provide more precise and efficient assistance for surgical procedures.

Meanwhile, in the direction of minimally invasive large-organ implantation surgery, the team completed more than 40 animal experimental studies in 2023, successfully validated 17 related patents, and achieved verification and optimization of multiple innovative devices. Furthermore, regarding digital image segmentation technology for large organs, the team is actively maintaining close contact with domestic and international enterprises to jointly explore the application prospects of cutting-edge technologies. Research combining imaging and pathology is continuously accelerating the R&D process, driven by major research projects.

Professor Fan Ning emphasized,As one of the five major technology platforms of the Engineering Center, the team expects to launch commercialized products successively within three to five years, injecting new vitality into the medical technology sector and driving high-quality industry development.