SGH 160th Anniversary| Xinmin Weekly features a report on Shanghai General Hospital: Treatment Innovations——All for the Patient

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In October 2024, Shanghai General Hospital (Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, hereafter referred to as "Shanghai General Hospital"), a Grade-III Class-A comprehensive hospital with branches in both Hongkou and Songjiang and covering nearly 300,000 square meters, celebrated its 160th anniversary. Over these 160 years, as modernization surged forward, medical concepts and treatment technologies have advanced rapidly, and we now stand on the brink of an era powered by AI-driven diagnostics and care. Upholding its century-old mission of “serving the people,” Shanghai General Hospital is actively pursuing “six transformations” and establishing “six high-standard bases,” bringing its vision of the “hospital of the future” into reality. Through these efforts, the hospital aims to make advanced medical technology and superior healthcare management tangible and accessible for patients, further supporting Shanghai’s development into a global medical center.

In commemoration of Shanghai General Hospital's 160th anniversary, the 38th issue of Xinmin Weekly in 2024 features a series of special reports celebrating our hospital's legacy.

This issue introduces the article, "Treatment Innovations: All for the Patient."

Medical services are the foundation and strength of the hospital. After years of development, Shanghai General Hospital has become a research-oriented hospital with distinct specialties. The hospital adheres to a strategic discipline layout based on “leveraging advantages and complementing needs,” focusing on building a “5+5+1” discipline development structure. This structure includes five flagship clinical centers—Ophthalmology, Urology, General Surgery (Digestive), Orthopedics, and Oncology; five priority clinical centers—Cardiovascular, Neurology, Women’s and Children’s Health, Trauma, and Major Vascular Interventions; and one specialty discipline group focused on Anti-Aging Medicine.

The hospital currently hosts one National Clinical Research Center, one Ministry of Education Key Discipline, nine National Clinical Key Specialties, and multiple Shanghai Clinical Medicine Centers, Emergency Centers, Key Medical Disciplines, and Control Centers, as well as research institutes and key laboratories.

Alongside developing medical technology, Shanghai General Hospital has further enhanced the efficiency of medical resource usage through resource integration and scientific management, exploring innovative management models like the “One-Bed System,” allowing more patients access to high-quality medical resources.

Confronted with treatment challenges, the commitment to find solutions is deeply embedded in Shanghai General Hospital’s culture. For instance, in 2021, a patient (Ms. Cheng, pseudonym) was diagnosed with refractory acute leukemia, complicated by genetic mutations. To control her disease and extend her survival, the only option was a hematopoietic stem cell transplant. The “haploidentical allogeneic hematopoietic stem cell transplant” is one of the most challenging forms of stem cell transplantation, with a high technical demand for post-transplant rejection monitoring and infection management.

At 68 and with underlying conditions like pulmonary hypertension, Ms. Cheng's situation was further complicated. Traditionally, leukemia patients over 60 were not considered suitable candidates for stem cell transplantation. However, Professor Song Xianmin, Director of the Hematology Department at Shanghai General Hospital, and Professor Wan Liping, the Executive Director (Southern Branch), led their team in developing tailored emergency plans after a multidisciplinary assessment. With the family’s consent, the team performed a haploidentical transplant. A year later, follow-ups showed the healthy stem cells had “taken root” in her bone marrow, enabling her to return to a normal life. Since 2017, when Shanghai General Hospital’s Hematology Department conducted a similar transplant for a 67-year-old—the oldest such case at the time—the team has repeatedly expanded the age range for these procedures, with a reported post-transplant survival rate of around 60% for elderly leukemia patients.

For every physician, finding even a single lifeline for patients is a lifelong pursuit. With the support of advanced technologies, Shanghai General Hospital's physicians are dedicated not only to achieving effective treatments but also to restoring health with minimal cost to the patient. This approach is especially evident in breast cancer treatments within the General Surgery Center. Traditionally, breast cancer treatments primarily involved surgery, which often impacted patients both physically and psychologically. In the past decade, breast-conserving surgery has become more common; however, the Breast Surgery Department at Shanghai General Hospital believes in going further, striving for “scarless” surgeries.

In 2022, under the assistance of the fourth-generation Da Vinci robotic system, Dr. Zhu Li’s team at the Northern Breast Surgery Department performed Shanghai’s first total subcutaneous mastectomy with axillary sentinel lymph node biopsy and immediate implant-based breast reconstruction. Over the past two years, the team has amassed significant experience, attracting patients from across the country. “Moving the incision to the patient’s armpit not only reduces infection rates and aids recovery but is also aesthetically beneficial, helping patients regain a sense of normalcy in their lives,” Dr. Zhu Li explained.

Neurosurgery, involving the brain, spinal cord, and peripheral nervous systems, presents inherent high risks, requiring surgeons to precisely locate lesions before surgery and avoid damaging surrounding vessels, nerves, and other critical structures during the procedure.

In July 2024, Ms. Yang from Xi’an (pseudonym) sought hope at Shanghai General Hospital’s Neurosurgery Department after an optic nerve sheath meningioma, pressing on her optic nerve and impairing her vision, was found in her left eye socket. Neurosurgery Director Dr. Lou Meiqing recommended three approaches: minimally invasive transnasal surgery, craniotomy, or minimally invasive trans-eyelid surgery. Considering the tumor’s deep location, Dr. Lou suggested the trans-eyelid approach. Dr. Lou explained that this method allows access to key anatomical areas while concealing the incision within the eyelid fold, leaving nearly no visible scars post-surgery.

Inflammatory bowel disease (IBD), a chronic and recurrent intestinal inflammation, has increasingly affected patients in China, impacting their growth and quality of life. With advancing medical technologies, the IBD treatment team in Shanghai General Hospital’s Gastroenterology Department has adopted fecal microbiota transplantation (FMT) as a new treatment method for this challenging disease.

IBD can involve multiple organ systems and a range of complications, requiring multidisciplinary treatment (MDT) for a holistic and comprehensive approach. For severe cases, Chief Physician Dr. Zeng Yue leads an MDT team including dieticians for nutritional assessment, psychologists for mental health support, and radiologists, laboratory physicians, and pathologists for diagnostic and complication assessments. This team has provided precise and personalized treatment for patients affected by IBD for many years.

In recent years, Shanghai General Hospital has focused on minimally invasive and precision treatments, performing a series of high-complexity surgeries.

"Firsts" in Innovation: New Technologies Bring New Hope

Medical knowledge is advancing rapidly, with new treatment methods and technologies emerging continuously. To provide patients with more precise and high-quality medical services, Shanghai General Hospital has long been committed to medical innovation, pioneering numerous "firsts" that have reduced patients' pain and brought them renewed hope. The hospital’s orthopedics team is one such group constantly at the forefront of medical innovation. Back in 2007, Professor Ma Jinzhong’s team was the first in China to perform the minimally invasive DAA hip replacement surgery, which replaces the hip joint through the intermuscular space, significantly reducing soft tissue damage. This innovation has greatly alleviated postoperative pain and improved joint stability for many patients. Yet, the team didn’t stop there. Recognizing the limitations of a purely manual approach to the minimally invasive DAA procedure, Professor Ma and his team sought improvements. They introduced a "bikini incision" along the inguinal skin fold, combining it with the advantages of the intermuscular minimally invasive approach to enhance both skin healing and aesthetics.

In 2023, Shanghai General Hospital performed a nationwide first: a surgery that integrated a cosmetic incision, custom artificial joint, and "copy-level" precision replacement, all achieved with the assistance of the MAKO robotic system. This is just one example of the many "firsts" at Shanghai General Hospital. In 2019, Professor Qiu Zhengjun's team from the Department of General Surgery completed China's first AI eye-tracking and 4K ultra-high-definition glasses-free 3D laparoscopic surgery. Surgeons, without wearing 3D glasses, could see ultra-clear 3D images of the patient’s abdominal cavity, enhancing both surgical efficiency and accuracy while aligning with the modern surgical principles of "precision, minimal invasiveness, and rapid recovery," all without increasing patients’ financial burden.

In 2019, Shanghai General Hospital established the "Robotic Surgery Center," partnering with its Clinical Research Institute’s Medical Artificial Intelligence and Biomedical Engineering Interdisciplinary R&D Center. This center has refined robotic surgery systems for various complex procedures in urology, general surgery, thoracic surgery, obstetrics, and gynecology, improving quality, safety, and efficiency through a comprehensive, meticulous project management system.

In 2021, the team led by Professor Wan Rong, the Executive Director of the Gastroenterology Department (Northern Branch), performed China’s first MUSE endoscopic fundoplication for a patient suffering from gastroesophageal reflux disease (GERD) for many years. This procedure has since become a standardized clinical treatment for moderate to severe GERD, promoting its wider clinical application.

In 2023, the Trauma Clinical Center Director, Dr. Lin Haodong, and Chief Physician Wang Jiandong led a team to complete closed reduction and minimally invasive internal fixation for a complex pelvic fracture and a femoral neck fracture, assisted by the "Holosight Intelligent Visualization System" robot. This marked the debut of the Holosight robot in Shanghai. This system integrates Mixed Reality (MR) and high-precision optical tracking technology, continuously monitoring the process of pelvic fracture reduction and creating a real-time, visual 3D model to assist surgeons in performing precise minimally invasive orthopedic procedures. It shortens surgery time, reducing intraoperative bleeding and radiation exposure, making trauma treatment more minimally invasive, precise, and intelligent, embodying the principles of Enhanced Recovery After Surgery (ERAS) in modern medicine.

Enhancing Top-Level Design: Patient-Centered Healthcare

The "14th Five-Year Plan for Shanghai’s Health Development" indicates that the proportion of early detection for common malignant tumors in Shanghai has risen above 35%, exceeding the national average. Nevertheless, further refinement of the service system remains a development goal. Comprehensive hospitals are pivotal in China's healthcare system. The "Healthy Shanghai 2030 Initiative" emphasizes implementing standardized treatment protocols for common cancers and promoting the standardized diagnosis and treatment of cancer. In recent years, leading figures in the medical system have also highlighted the imperative need for establishing oncology centers in major comprehensive hospitals.

Since 2022, the Shanghai Shenkang Hospital Development Center has been driving the establishment of municipal cancer comprehensive treatment centers (COC), with Shanghai General Hospital as one of the first pilot hospitals. It has led the drafting of SOPs and standardized forms for bladder cancer and hypopharyngeal cancer diagnosis and treatment while also participating in the formulation of cancer diagnosis and treatment standards for Shanghai’s COC initiative. Shanghai General Hospital recognized early on that cancer treatment and prevention require a multi-disciplinary approach and introduced the German Comprehensive Cancer Center (CCC) model in 2018. This approach offers one-stop, standardized diagnosis and full-process disease management for all cancer patients. Since the launch of the COC initiative, Shanghai General Hospital has rapidly leveraged the CCC model to establish a localized comprehensive cancer treatment center. To date, the hospital has implemented 23 structured electronic cancer medical records and built an oncology information platform, creating a patient-centered, comprehensive, and standardized cancer diagnosis and treatment model unique to Shanghai General Hospital.

This patient-centered, integrative service model has already been extended to other disease treatments. Starting in 2024, for patients with complex diabetic eye diseases requiring urgent surgery but with uncontrolled blood sugar, Shanghai General Hospital has officially launched the city’s first diabetic eye disease fusion ward. With a high prevalence of diabetes and its associated complications posing severe health risks, many patients with diabetic retinopathy reach advanced stages with significant systemic comorbidities. Surgical complexity and perioperative safety become critical challenges. The fusion ward is managed collaboratively by the Department of Ophthalmology and the Endocrinology and Metabolism Department, pioneering a one-stop diagnosis and treatment model for complex diabetic eye disease cases.

In 2024, Shanghai General Hospital Establishes City's First Integrated Ward for Diabetic Eye Disease

Shanghai General Hospital has pioneered the city's first integrated ward specifically for diabetic eye disease. In the Ophthalmology Department, the hospital follows a “one-bed-per-need” model, meaning that as many integrated beds as needed can be made available for patients requiring collaborative care. The average hospital stay has now been reduced to 4.5 days, nearly one-third shorter than before. The hospital is vigorously promoting a “one-bed-per-hospital” model, addressing the common challenge of bed scarcity in hospitals. Under this model, all hospital beds are centrally managed, allowing patients to be admitted to any available bed across departments, effectively turning department-specific beds into shared resources. This new approach has significantly improved patient admission efficiency, with available beds now kept at a minimum.

Shanghai General Hospital has also embedded pain management throughout the entire patient care process. In 2020, the hospital established its "Pain-Free Hospital Initiative," spearheaded by the Department of Anesthesiology. This initiative advances "comfort medicine" across both outpatient and inpatient settings. "From the moment a patient is admitted, we begin pain management interventions. With comprehensive perioperative pain management, we aim to optimize patients’ physical, psychological, and physiological functions, which helps enhance patient satisfaction and promotes postoperative recovery."

After more than 160 years of development, Shanghai General Hospital is now at a new starting point. According to Ms. Zhu Li, the Medical Affairs Director (Northern Branch), and Ms. Li Qun, the Medical Affairs Director (Southern Branch), the hospital plans to release a "Clinical Playbook" white paper, which will cover more than 100 clinical pathways across various departments. Collaboration across multiple departments is essential to provide the highest quality care, akin to performing a symphony. This "Clinical Playbook" represents valuable experience and effective practices the hospital has accumulated over the years in clinical services and reflects its commitment to enhancing clinical care. It will be instrumental in supporting the hospital's high-quality growth.

Source: Issue 38, 2024, Xinmin Weekly
Journalist: Zhou Jie
Editor: Publicity and Spiritual Civilization Office, Cai Shishi

Translator: International Cooperation and Exchange Department,Yuhan Wang