Tamás Mersich1, Wenjun Huang2
1Department of Visceral Surgery, National Institute of Oncology, Budapest, Hungary; 2HBSN Editorial Office, AME Publishing Company
Editor’s note
The 10th Joint Conference of the University of Chicago and PUMCH Liver Surgery was successfully held in Beijing, China on Sept 6 to 7, 2024. This year’s conference focused on Minimally Invasive Surgery and Adjuvant therapy for Hepatobiliary and Pancreatic Disease. Taking this opportunity, we conducted an interview with Dr. Tamás Mersich from Department of Visceral Surgery, National Institute of Oncology, Budapest, Hungary.
Expert’s introduction
Tamás Mersich’s curriculum vitae is as follows.
Education/Qualifications
1994-2000 Semmelweis University, Medical Faculty, Budapest
2007 Qualification of Surgeon
2007 PhD degree, Semmelweis University, PhD School
2009 Consultant surgeon
2010 Qualification for gastroenterology
2020 Qualification for medical oncology
Employment to Date/Work Experience
2000-2007 Surgeon at Uzsoki Teaching Hospital
2007-2014 Leader of the US-team in Surgical Unit in Uzsoki Teaching Hospital Budapest
2008-2014 Onko-team member in Uzsoki Teaching Hospital
2010-2011 Leader of Outpatient Unit in Uzsoki Teaching Hospital
2011-2013 Leader of Operating Unit in Uzsoki Teaching Hospital
2013-2014 Deputy Leader of Department of Surgery and Oncosurgery in Uzsoki Teaching Hospital
2014-present Head of Visceral Surgery at National Institute of Oncology
Other Experience/Leadership/Social activities
1999-2010 WHMA (World Hungarian Medical Academy) member of curator Board
2010 Establishing Member of Hungarian Society of Patient’s Safety
2011- Member of European Association of Endoscopic Surgery (EAES)
2015- Member of Executive Board of Hungarian Society of Oncology
2015- Member of Executive Board of Hungarian Society of Minimally Invasive Surgery
2017- Member of Executive Board of Hungarian Society of Surgery
2018-2021 National Delegate European Society of Coloproctology (ESCP)
Interview
HBSN: Can you briefly introduce the advantages and limitations of minimally invasive liver surgery?
Dr. Mersich I think the liver is a complex organ with different types of diseases. In my country, metastasis is the most common condition we treat in the liver. Colorectal liver metastases are different from primary liver tumors, such as hepatocellular carcinoma (HCC) and cholangiocarcinoma. We have to consider that colorectal liver metastasis and their recurrences affect the liver itself. As a liver surgeon, I think it is extremely important to preserve as much liver parenchyma as possible during surgery. This, I believe, is the main limitation of minimally invasive surgery on the liver today. On one hand, minimally invasive surgery offers patients a shorter hospital stay, reduced post-operative pain, and quicker recovery, allowing them to return to chemotherapy sooner.
On the other hand, if the trade-off is that patients lose more liver parenchyma due to excessive resection caused by minimally invasive access, this becomes an important limitation. Once we operate on one or two foci, which are easily accessible or removable without major loss of hepatic tissue, minimally invasive surgery—whether laparoscopic or robotic—should be the choice. However, if a major resection is needed solely due to the limitations of the technology, we should avoid that approach. In such cases, we can take advantage of parenchyma-sparing open surgery. That’s my point: we should prioritize preserving parenchyma first, and consider minimally invasive surgery second.
HBSN: What do you think is the future development of minimally invasive liver surgery with AI and 3D’s improvement?
Dr. Mersich: Yes, there has been a lot of improvement. Nowadays, there are software programs in radiology departments that can reconstruct 3D images from MRI or CT scans. These programs can also model the biliary anatomy, as well as the locations of foci, metastases, and tumors in the liver, showing their exact positions relative to vessels and bile structures.
There is no doubt that AI will advance liver surgery. The question is how we can translate it into real-world surgical technology. One possibility is that we may be able to view real-time MRI or CT scan images during surgery. This is one opportunity.
Another possibility is that we may only need to analyze the images before surgery, and then our brain can follow the steps and guide the operation. I think in the near future, AI will drive robotic surgery based on preoperative images. While this is still far from becoming a reality, it may be the future. Perhaps a combination of ablation or ablative technologies with AI will be introduced first, and later, AI may reach liver surgery.
HBSN: What are the advantages of the use of robotic surgery of abdominal tumors?
Dr. Mersich: Yes, I think the robot is a very successful tool, especially when the exposure of the area is quite demanding or difficult. The robot becomes invaluable when an open or laparoscopic procedure is too challenging to access. For example, in deep rectal cancer with a narrow pelvis, or when operating on the posterior segments of the liver, accessing the SMA during pancreatic resections, or performing proper lymph node dissection in gastric cancer surgery.
These are the fields where I see the clear advantages of robotic surgery, particularly in terms of exposure and fine movements. With the robot, we can get a zoomed, detailed picture, a constant 3D view, and very fine, precise access to structures without causing injury. This is especially important in sphincter-preserving rectal procedures, challenging segments of the liver, lymph node harvesting in gastric cancer surgery, or even in right hemicolectomies when performing central mesocolic excisions. In my opinion, the robot is especially beneficial in these procedures.
HBSN: What is the biggest challenge you have met during your study and career? How do you overcome them?
Dr. Mersich: I think the biggest challenge for a surgeon in the oncological field is knowing when to say no to patients. There are times when I don’t recommend surgery at all because of the stage of the disease. It’s a lesson that we learn day by day. There are obvious factors influencing your decision, beyond just the reality of the situation. There may be pressure from patients, their families, your institution, or perhaps the case involves a tumor that has never been operated on before, or one deemed inoperable by another institution. These factors can influence your decision-making.
I feel that the most challenging situation in my career has always been knowing when to say no. Sometimes, I fear that I have failed to do so.
Question: As an experienced oncologist and professor, what advice would you give to younger physicians who would like to engage in your field?
Dr. Mersich: My advice is that, if you want to become a well-qualified oncological surgeon, you need to learn general surgery and the basics of surgery first. Then, you should specialize in oncology and broaden your perspective by staying updated on new surgical technologies. Because as an oncologist, you can better understand the limitations and boundaries of other treatment options available to your patients. This helps in assessing risks and taking the optimal approach during procedures. If you are the last resort for a patient, you may need to take more risks, but if there are still other treatment options available, you can be more cautious in radicality.
I would tell young surgeons that things are not as simple as they may seem at first. You need to stay aware of new developments, take a multidisciplinary approach, and regularly question everything you think you already know.