Nearly Four Decades in the Pursuit of Biliary Surgery: Training, Research, and Mentorship

Abstract

Biliary surgery is a highly demanding field that requires advanced anatomical knowledge, refined surgical techniques, and meticulous perioperative management, all of which can only be achieved through long-term training and accumulated experience. In this article, based on the Presidential Lecture delivered at the 61st Annual Meeting of the Japanese Society of Biliary Surgery, the author reflects on nearly four decades of clinical practice, research, and education devoted to biliary surgery.

During the early years of surgical training, experiences in the pioneering era of hepatic resection-including trial-and-error approaches and encounters with operative mortality-highlighted the critical importance of anatomical understanding and surgical safety in liver surgery. Subsequently, intensive training in hepatobiliary and pancreatic surgery at the National Cancer Center Hospital and the first department of surgery of Nagoya University Hospital provided extensive experience in hepatectomy with biliary reconstruction and extended surgery for advanced biliary tract cancer, forming the foundation of the author's career as a biliary surgeon.

Through engagement in basic and clinical research, the author learned the importance of scientifically addressing clinical questions arising from daily practice and disseminating evidence to support surgical decision-making. Extended hepatectomy with vascular resection for perihilar cholangiocarcinoma and randomized controlled trials evaluating Pringle maneuver ischemic intervals exemplify this approach. Since 2014, at Aichi Medical University, efforts have focused on establishing a high-level hepatobiliary surgical program, educating young surgeons, and introducing robotic-assisted surgery.

This lecture reaffirms the core principles of biliary surgery and emphasizes the enduring value of case reports and operative articles as a means of transmitting surgical knowledge and culture to the next generation.