Surgery has passed through an intuitive and an empirical era and has now entered its modern phase characterized by everincreasing certainty in surgical practice. 1 The enormous progress in biomedicine, the rise of evidence-based medicine, and the consensus on the need for humanistic patient care in the 21 st century have laid a foundation for a new surgical paradigm. This surgical paradigm featuring high-certainty clinical practice would enable simultaneous optimization of therapeutic

more »

... ess, surgical safety, and minimal invasiveness. We argued for the necessity of a paradigm shift in liver surgery, and advocated "precision liver resection" as a surgical concept for the first time in 2006, 2,3 and later extended the concept of "precision liver resection" to "precision liver surgery." 4,5 This concept is widely applicable within various surgical fields and is embraced by both the Chinese and international community. In this review, we advocate the new paradigm of "precision surgery" and attempt to establish its theoretical and technological framework by examining the evolution of surgery, the advances in surgical science and technology, and the health care needs within modern society. "Precision" does not just refer to the accuracy of operative manipulation, some idealized procedure, or a particular advanced technology, 6,7 "Precision" as we define it is a new approach to surgery and its derived system of theories and technologies covering all the elements of surgical practice, including preoperative evaluation, clinical decision making, surgical planning, operative manipulation, and perioperative management. 3 Emergence of Precision Surgery Surgery, as a direct and profound exploration of the human body, has always been a symphony of science and art. In this everlasting symphony, the surgical paradigm has evolved Keywords ► precision surgery ► liver surgery ► certainty ► multiobjective optimization Abstract 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.