Session Category List

Recent advances in artificial intelligence (AI), robotics, and digital technologies are changing the field of hepato-biliary-pancreatic (HBP) surgery. In addition to the increasing use of robotic surgery, new technologies such as AI-assisted surgery, surgical video analysis, digital operative records, and the use of clinical and surgical data are being introduced into clinical practice, research, and education. However, how we should incorporate and use these technologies in HBP surgery remains to be discussed. In this session, we will share current approaches and future possibilities of AI, robotics, and digital technologies, and discuss how these technologies may change clinical practice, surgery, research, and education in HBP surgery. We will also discuss how the next generation of HBP surgeons should use these technologies and contribute to the future development of HBP surgery.

In HBP surgery, an important challenge is how to train the next generation of surgeons and pass on surgical skills while maintaining patient safety and good surgical outcomes. Young surgeons seek more operative experience, while supervising surgeons must carefully consider when and how much responsibility can be given to them. In this session, we will share current approaches to surgical training and skill transfer in liver, biliary, and pancreatic surgery and discuss these issues from the perspectives of both young and senior surgeons. Using operative videos where appropriate, we will also discuss difficult intraoperative decisions and differences in judgment between young surgeons and experts. Through these discussions, we aim to consider how we can better train the next generation of HBP surgeons.

For "resectable" hepatocellular carcinoma (HCC), hepatic resection remains a cornerstone of curative treatment. However, optimal management requires comprehensive consideration of tumor characteristics, liver function, vascular invasion, future liver remnant, and risk of recurrence.This symposium will address the indications and limits of hepatic resection, anatomical versus non-anatomical resection, minimally invasive surgery, strategies for borderline resectable or high-risk HCC, and integration with systemic therapy. Through current evidence and expert experience, we will explore how the Science of evidence-based treatment can be combined with the surgical Art of individualized decision-making to advance treatment strategies for resectable HCC.

This symposium will focus on contemporary treatment strategies for resectable perihilar cholangiocarcinoma from the perspectives of both science and art. The science of surgical treatment includes evidence-based assessment of resectability and operative planning based on high-quality imaging, detailed surgical anatomy, and pathological and oncological evidence. The art of surgery lies in meticulous operative technique and sophisticated intraoperative decision-making. This includes precise dissection, extended surgical procedures, and flexible modification of the planned operation according to unexpected intraoperative findings. We welcome presentations addressing how objective scientific assessment and refined surgical expertise can be integrated to maximize the safety, curability, and oncological effectiveness of surgery for resectable perihilar cholangiocarcinoma.

The treatment of resectable pancreatic ductal adenocarcinoma (PDAC) is evolving from a surgery-first approach toward an integrated strategy combining preoperative therapy, surgery, adjuvant therapy, and perioperative management. The survival benefit demonstrated by preoperative gemcitabine plus S-1 in the Prep-02/JSAP-05 trial has further prompted reconsideration of the role of upfront surgery.
However, important questions remain regarding patient selection, the optimal preoperative regimen and duration, assessment of treatment response, and the timing of surgery. At the same time, surgical expertise remains essential for achieving an R0 resection while minimizing unnecessary surgical extension, appropriately applying minimally invasive and vascular resection techniques, and tailoring treatment to elderly and frail patients.
This symposium will explore resectable PDAC from two complementary perspectives: “Science,” based on contemporary clinical evidence, real-world data, advanced imaging, and molecular insights; and “Art,” represented by the experience and judgment required to determine the optimal indication, timing, and extent of surgery.
The question is evolving from “When should we operate?” to “Why should we operate on this patient, and why at this particular time?”
By integrating Art and Science, we aim to define the next generation of surgical strategies for resectable PDAC.

Advances in systemic therapy, including immune checkpoint inhibitors (ICIs), have broadened treatment options for advanced hepatocellular carcinoma. This session will explore definitions of unresectability and conversion surgery from an international perspective discussing the validity and limitations of the R/BR1/BR2 classification proposed in Japan, which groups patients by the expected oncological benefit of resection. Treatment strategies and long-term outcomes will also be examined in relation to functional conversion (treatment-related changes enabling safe resection with an adequate functional liver remnant) and oncological conversion (reduced tumor burden, regression of vascular invasion, or sustained disease control supporting curative-intent resection). Key questions include whether ICI-based regimens have increased conversion-to-resection rates and whether patients likely to benefit from surgery can be identified. This session will also discuss the selection of systemic and locoregional therapies, the optimal timing of resection, and the role of adjuvant systemic therapy.
Presenters are invited to define initial unresectability, to describe changes in oncological and hepatic functional status during multidisciplinary treatment, and to report conversion-to-resection rates, long-term outcomes, and prognostic factors. We also welcome analyses of all patients from treatment initiation, including those who do not undergo resection, and studies assessing the added value of surgery. Drawing on international experience, we aim to clarify the role of conversion surgery in multidisciplinary care and to establish strategies for the improvement of long-term outcomes.

With recent advancements in anticancer drugs and immunotherapy, the number of conversion surgeries for initially unresectable advanced biliary tract cancer has been increasing. However, many challenges remain to be clarified, such as the optimal regimen selection leading to conversion surgery, the timing and criteria for surgery, the choice of surgical procedure, key technical points for safely performing surgery, long-term post-operative outcomes, and factors contributing to long-term survival. This panel discussion will serve as a platform to broadly solicit presentations on each institution's proactive and successful treatment strategies for biliary tract cancer, focusing on regimen selection, optimal surgical timing and indications, and surgical approach. We will also delve into discussions on long-term post-operative outcomes and factors contributing to extended survival, aiming to envision future advancements in this field.

Advances in chemotherapy and chemoradiotherapy for pancreatic cancer have led to reports of long-term survival following conversion surgery. However, some patients experience early postoperative recurrence, underscoring the need to identify treatment strategies that further improve long-term outcomes.
In this panel discussion, we invite presentations on institutional treatment strategies and outcomes for both locally advanced and metastatic pancreatic cancer. We will discuss preoperative treatment regimens, criteria and optimal timing for surgery, the proportion of patients who proceed to conversion surgery (resection rate), and postoperative adjuvant therapy, with the aim of identifying strategies that increase opportunities for resection and improve long-term outcomes.

In living donor liver transplantation, donor safety is the highest priority. Since 2026, all minimally invasive donor hepatectomy have been covered by the Japanese national insurance, with expected benefits including smaller incisions, less postoperative pain, faster recovery, and improved cosmetic outcomes. However, important challenges remain, including bleeding control in a limited operative field, management of vascular and biliary anatomical variations, prevention of graft injury, and timely conversion to open surgery.
Safe and sustainable implementation requires clear indications, standardized surgical techniques, structured training that considers the learning curve, effective team responses to emergencies, and mid- to long-term evaluation of both donor and recipient outcomes.
In this panel discussion, we will share institutional experiences, technical innovations, outcomes, and challenges, and discuss future directions for the safe dissemination and further development of minimally invasive donor hepatectomy.

Recurrence remains a major challenge after curative-intent resection for hepatocellular carcinoma, biliary tract cancer, and pancreatic cancer, and conventional imaging and serum tumor markers have limited ability to detect residual disease at an early stage. Circulating tumor DNA (ctDNA)-based assessment of molecular residual disease (MRD) is emerging as a promising biomarker for postoperative risk stratification, early detection of recurrence, and monitoring of response to neoadjuvant therapy.
This session will review current evidence on ctDNA/MRD in HPB cancers, with a focus on differences in ctDNA shedding across tumor types, optimal sampling time points, assay platforms, and the distinction between clinical validity and clinical utility. We will also discuss the potential and limitations of ctDNA-guided perioperative systemic therapy, including treatment escalation for ctDNA-positive patients and whether de-escalation for ctDNA-negative patients can be justified given the limited sensitivity of current assays. Finally, we will consider how prospective clinical trials should be designed to test MRD-guided treatment personalization.

In hepatobiliary-pancreatic surgery, which requires advanced surgical skills and rigorous perioperative management, establishing patient safety is an urgent priority. At the core of these efforts, Morbidity and Mortality (M&M) conferences serve not merely as a platform for case reporting or retrospective reflection, but as the foundational pillar for quality improvement and recurrence prevention. However, variations exist among institutions regarding how its purpose, role, and practical utilization are defined.
The objective of this session is to clarify the fundamental role that M&M conferences should fulfill in patient safety. We will examine practical operations across different institutions, covering root-cause analysis of incidents, system-level improvements that avoid placing individual blame, the cultivation of non-technical skills through time-outs and debriefings, and the positive downstream effects on multidisciplinary teamwork.
By redefining the clear role and position of M&M conferences, we aim to thoroughly discuss sustainable patient safety frameworks that effectively translate lessons learned into meaningful clinical practice improvements.

The JSHBPS board certification system for expert surgeons has evolved to promote advanced surgical skills and the safe delivery of hepato-biliary-pancreatic (HBP) surgery. Since the first board-certified expert surgeons were accredited in 2011, nearly 800 surgeons have been certified, and the system is now entering a new phase. The next important question is how certification can serve not as an endpoint, but as a platform for continued professional development and contribution to the field.
This workshop will explore diverse career paths after certification, including continued refinement as a high-level operator, transition to roles as trainers and educators, leadership in academic centers, major hospitals and regional healthcare, research and international activities, engagement with minimally invasive and other emerging technologies, and sustainable career development across different life stages. We welcome presentations that share individual or institutional experiences, successful models, unmet needs, and proposals for improving the system. Through these discussions, we aim to define how board-certified expert surgeons can continue to grow, contribute, mentor the next generation, and shape the future of HBP surgery in Japan.

As work-hour restrictions become part of daily clinical practice, new approaches to HPB surgical education are needed. Training is becoming more complex, requiring skills in open, laparoscopic, and robotic surgery. Providing sufficient training opportunities while ensuring patient safety and helping trainees become independent surgeons remains a major challenge.
This workshop invites presentations from both trainees and trainers on topics such as operative experience, perioperative management, video-based and simulation training, assessment of surgical skills and decision-making, and reducing the burden on trainers. We aim to share experiences and challenges across institutions and discuss how to provide effective and sustainable HPB surgical education under work-hour restrictions.

With the increase of aged popoulation and improved curative outcomes for various teypes of diseases in Japan, the patietns with super-faged patients over 80 years old and/or frail patients has been incerasingly indicated for hghly difficult hepatobiliary and pancreatic surgeries. In order to maintain acceptable outcomes under these conditions, it is important to address appropriate indication of such surgeries, to modifily surigcal procedures flexibly and to apply multidisciplinary interventions during perioperative priods. Another issue in such contion includes identificatin of specific prognostic factors among various indexes for fraility and immuno-nutiritional status, to adopt efective peri-operative strategies for better outcomes. The main topics in this session include how to apply, judge, or modify the indication of highly difficulty hepatobiliary and pancratic surgeries for super-aged or those with fraility, with ingenuities in perioperative invterventions and surgical procedures in each faculty.

In HPB surgery, balancing the prevention of post-hepatectomy liver failure with oncological curability remains a critical challenge. Advances in imaging, portal vein embolization (PVE), ALPPS, and hepatic vein deprivation (HVD), alongside perioperative management and insights into liver regeneration, have expanded surgical indications for complex cases.This workshop aims to discuss the future of safe and curative HBP surgery by sharing surgical/interventional approaches, perioperative strategies, advanced functional evaluations, and innovative basic research focused on improving hepatic reserve.

Conversion surgery following prehepatectomy chemotherapy for advanced colorectal liver metastases represents a pioneer of conversion therapy now applying to various cancers. However, criteria for oncological or technical resectability still defined clearly and the optimal timing for conversion surgery as well as the prognostic factors following resection have yet been fully investigated. Further, several unresolved issues persist regarding the appropriate surgical procedure (e.g., resection combined with portal/hepatic vein embolization, staged hepatectomy, or ALPPS) and the feasibility of adopting minimally invasive surgery or liver transplantation. In this session, an active discussion aimed at addressing these challenges will be expected.

The optimal surgical strategy for pancreaticobiliary maljunction without biliary dilatation remains controversial regarding simple cholecystectomy versus prophylactic bile duct resection. Long-term outcomes, including late complications (e.g., biliary stricture, recurrent cholangitis, intrahepatic stones) and carcinogenesis risks after simple cholecystectomy, are also insufficiently clarified. This session aims to discuss optimal surgical strategy and indications for prophylactic resection based on institutional long-term data. Given the rarity of this condition, we welcome both case-series studies and case reports on complications or carcinogenesis.

Since the release of the “Tokyo Guidelines 2018,” laparoscopic cholecystectomy has come to be actively performed even for severe acute cholecystitis. The guidelines’ explicit recommendation of “bailout surgery” as a surgical approach for cholecystectomy has had a significant impact; this approach has gained widespread acceptance, and the number of such cases is believed to be increasing. We hope this session will serve as a forum for sharing strategies and technical approaches regarding challenging cases of cholecystectomy involving severe inflammation, as well as serious complications such as bilio-vascular injuries, techniques of bailout surgery, and preliminary long-term outcomes.

Assess the success of biliary reconstruction by sustained bile drainage, preserved liver function, and the absence of early bile leakage. Anastomotic stricture and recurrent cholangitis can cause bile stasis, intrahepatic stones, and late liver injury. This session will address preserving the bile duct blood supply, creating an adequately sized, tension-free anastomosis, and designing the reconstructive route. We will also discuss the knack for early diagnosis of biliary complications and the treatment selection criteria among endoscopic, percutaneous treatment, and reoperation. By sharing experiences of both successful and challenging cases, we aim to improve long-term liver function and quality of life of patients undergoing biliary reconstruction.

In Japan, peptide receptor radionuclide therapy (PRRT) was introduced into daily practice of NET treatment in 2021, and now it is placed as the first-line treatment for somatostatin receptor-positive NET G2/G3 tumors as well as NET G1 tumors with high tumor burden. The circumstances surrounding treatments for distant-stage NET have recently dramatically changed, and novel multidisciplinary treatment strategy including surgical resecton is urgently needed. In this workshop, the experts in this field (surgeon, medical oncologists, gastroenterologists, and radiologists) are requested to summarize the recent drastic changes in the treatments for advanced/ recurrent pancreatic NET and to propose best practice for this refractory disease. Especially, the role of surgical treatment in the multidisciplinary approach is to be discussed.

Given the limited number of available organs, a key challenge for the further development of liver transplantation is how to evaluate and safely utilise grafts that have traditionally been regarded as ‘marginal’. However, the definition and acceptable range of marginal grafts are not uniform; a comprehensive assessment is required, taking into account not only donor factors but also the recipient’s clinical condition, urgency, the experience and technical capabilities of the transplant centre, and perioperative management.
In this session, we aim to hold a wide-ranging discussion on the experience and outcomes of using marginal grafts at various centres, decisions regarding graft acceptance and suitability, donor–recipient matching, and the potential for evaluation, preservation and treatment using machine perfusion, as well as innovations in immunosuppressive therapy and perioperative management. We aim to share not only successful cases but also experiences involving instances where use was abandoned or graft failure occurred, thereby providing an opportunity to reconsider the question: ‘Which grafts should be used for which recipients, and under what conditions?’.

Hepato-biliary-pancreatic (HBP) surgery is a highly specialized field that requires advanced expertise and continuous professional development. As the working environment for surgeons continues to evolve, career paths in HBP surgery are becoming increasingly diverse, reflecting individual goals and values.
For women HBP surgeons to develop their expertise and pursue fulfilling careers, professional development, work-life balance, leadership, and a supportive working environment are all important considerations.
This session welcomes a broad range of perspectives, including the experiences and future aspirations of women HBP surgeons, as well as initiatives from mentors and institutions. By sharing diverse experiences and approaches, we hope to explore how surgeons can pursue their individual career goals and thrive in HBP surgery, regardless of gender.

HBP surgery imposes substantial physical and psychological burdens on surgeons due to demanding preoperative planning, prolonged and complex procedures, and intensive postoperative management. Surgical culture has traditionally valued dedication and perseverance despite fatigue or physical discomfort. Consequently, work-related musculoskeletal disorders (WMSDs), including neck, shoulder, and lower-back pain, may be common among surgeons but have not been sufficiently recognized or discussed. This workshop will address the prevalence and characteristics of WMSDs among HBP surgeons and residents, their relationships with operative duration, posture, and surgical environment, including laparoscopic and robotic surgery, as well as strategies for prevention and mitigation. We hope this workshop will promote discussion on creating a healthier and more sustainable career environment for current and future HBP surgeons.

Hepato-biliary-pancreatic (HPB) surgery requires precise understanding of complex three-dimensional anatomy and tumor extension to ensure both surgical safety and oncological adequacy. Recent advances in VR/XR and image-guided navigation enable patient-specific anatomy, critical vascular and biliary structures, and tumor margins to be visualized and integrated into the operative field.
This session will highlight innovative visualization and navigation technologies in HPB surgery and discuss how they can enhance intraoperative decision-making, improve surgical safety, and achieve oncologically precise surgery.

With the widespread adoption and technological advancement of minimally invasive liver resection, its indications have expanded to include technically demanding anatomical liver resections. Among these procedures, hepatic subsegmentectomy enables anatomical resection of the portal territory containing the tumor while maximizing preservation of the future liver remnant. However, the procedure requires an advanced understanding of hepatic anatomy and sophisticated surgical skills because of the anatomical variability of intrahepatic vascular structures and the technical challenges associated with identifying and controlling the target Glissonean pedicle, delineating the intended resection territory, and maintaining an appropriate parenchymal transection plane. In recent years, advances in navigation technologies, including preoperative 3D simulation, intraoperative ultrasonography, and ICG fluorescence imaging, together with the development of various approaches from the hepatic hilum or hepatic vein side and different techniques for accessing the Glissonean pedicle, have contributed to improving the safety and technical feasibility of minimally invasive hepatic subsegmentectomy. Nevertheless, surgical strategies vary considerably depending on the target subsegment, tumor location, and vascular anatomy, and a universally standardized technique has yet to be established. In this video symposium, we invite participating institutions to present their approaches to minimally invasive subsegmentectomy. Through the sharing of surgical techniques and strategies, we aim to facilitate discussion toward the standardization of minimally invasive subsegmentectomy.

Laparoscopic surgery for gallbladder cancer must balance minimally invasive techniques with oncological curability. In this video symposium, we will discuss indications, intraoperative decision-making, technical strategies, and limitations through videos of laparoscopic and robot-assisted surgeries. We are seeking a wide range of video presentations—including those based on experience with robot-assisted surgery—covering techniques that support curative intent and safety. Topics should include management of cases with suspected gallbladder cancer or incidentally discovered gallbladder cancer; determining the extent of resection and lymph node dissection based on intraoperative diagnosis; maneuvers to avoid gallbladder injury; and procedures such as liver resection, lymph node dissection, and biliary reconstruction. Furthermore, we welcome initiatives that incorporate minimally invasive approaches into multidisciplinary treatment, such as staging assessment via diagnostic laparoscopy, resection following preoperative therapy, and conversion surgery. Based on case selection and treatment outcomes, we aim to clarify the current status of laparoscopic surgery in gallbladder cancer treatment through discussions centered on surgical videos.

Robot-assisted distal pancreatectomy for pancreatic cancer that does not require major vascular resection has become increasingly performed in many facilities. On the other hand, some facilities choose not to perform robot-assisted surgery due to extended operating times compared to laparoscopic surgery, the unfavorable cost-effectiveness when considering depreciation and labor costs, and the lack of evidence regarding long-term prognosis. In 2026, the insurance point for robot-assisted distal pancreatectomy for pancreatic cancer increased, and some facilities can now also calculate a robot fee. However, when considering this as part of the national initiative towards consolidation, it is expected that laparoscopic distal pancreatectomy will also continue to be performed to some extent in the future. Therefore, the merits of robot-assisted distal pancreatectomy for pancreatic cancer must be evaluated from multiple perspectives, including not only perioperative outcomes but also long-term oncological effects, hospital management, attendance management in work style reform, education, and its positioning as an introductory technique for robot-assisted pancreatoduodenectomy. In this session, we would like you to discuss the benefits and assignments of robot-assisted distal pancreatectomy for pancreatic cancer from various perspectives.

Minimally invasive surgery, with magnified visualization and pneumoperitoneum, has improved recognition of membranous structures, tissue planes, and vascular anatomy that are difficult to appreciate in open surgery. In liver surgery, understanding of the intersegmental plane, Glissonean pedicles, Laennec’s capsule, and hepatic venous anatomy has advanced. In pancreatic and biliary surgery, knowledge of peripancreatic fascial planes, vascular and neural anatomy around major vessels, and tissue planes at the hepatic hilum and gallbladder has also deepened. In this workshop, we will share these anatomical insights, their application to surgical techniques, and their clinical significance through laparoscopic and robotic surgical videos, and discuss how they can be applied to daily practice.

Vascular dissection, vascular control, hemostasis, and vascular reconstruction techniques developed in liver transplantation play an important role in achieving oncological clearance while preserving remnant liver function. This video workshop invites presentations demonstrating the application of liver transplantation techniques to liver resection. Topics include vascular resection and reconstruction, liver mobilization, hilar dissection, vascular clamping, and techniques for achieving hemostasis. Presenters are encouraged to demonstrate surgical strategies, reconstruction planning, and key technical steps through operative videos. Open, laparoscopic, and robotic approaches are all welcome. We aim to discuss the indications and limitations of these techniques in terms of safety, oncological adequacy, and preservation of remnant liver function, while promoting the exchange of expertise and its transfer to the next generation of surgeons.

Hepatopancreatoduodenectomy (HPD) may offer the only opportunity for curative resection in selected patients with extensive cholangiocarcinoma. However, it is a highly technically demanding procedure associated with substantial perioperative morbidity and mortality, making rigorous patient selection and meticulous preoperative planning essential. Various strategies have recently been reported to reduce perioperative risk, including parenchymal-sparing approaches, pancreatoduodenectomy combined with hilar bile duct resection, modifications to the operative sequence, and refinements in reconstruction to prevent severe complications related to postoperative pancreatic fistula. This video workshop welcomes presentations of technical refinements in HPD and related procedures, regardless of the number of cases performed. Through video-based sharing of operative techniques and experience, we aim to discuss practical strategies to improve the safety of these challenging procedures.

Robot-assisted pancreaticoduodenectomy was covered by insurance in 2020, and the number of cases has increased, with an increasing number of institutions now expanding its indications to include invasive pancreatic cancer. However, cases with concomitant pancreatitis, anatomical variations, or tumor extension near the portal vein can be technically challenging and difficult to manage. Therefore, to promote the safe introduction and widespread adoption of the procedure, stabilize and further improve surgical outcomes, it is necessary to establish standardized surgical techniques. In this session, experienced institutions will present standardized surgical techniques, including indications for this procedure and methods for surgical field exposure and approaches that take advantage of the characteristics of robotic surgery, and discuss safe introduction and dissemination as well as future challenges.

This session will be led by a native English-speaking editor specializing in English-language medical manuscripts, providing fundamental training on effective presentation skills.
Following presentations of a case report or case series, participants will receive detailed feedback on their English expressions, pronunciation, presentation style, and overall structure. Ample time for personalized advice will be provided, serving as an intensive training opportunity for young physicians.
Eligibility: Physicians under 40 years of age, including residents.

Junior Residents (Postgraduate Year 1–2) and students interested in hepatobiliary and pancreatic surgery are highly encouraged to apply.