摘要：近30年微创外科的发展，使其进入了腹腔镜的年代，可是许多手术虽手术切口小了，但手术野出血仍然很多。几乎同时，完整系膜切除理念的推出，使人们开始认识到手术解剖层面的重要性，并将其发展为膜解剖，沿着膜解剖的规律去寻找“神圣层面”或“组织板块”，可以达到更完整意义上的微创。传统手术下的肉眼观察不易发现膜解剖的特征，只有当高清腹腔镜（乃至3D高清腹腔镜）或手术放大镜下，人们才能看到其具体标志。因此，将临床需求（微创）、基础研究（膜解剖）和工业发展（光学系统）这3个方面汇合到一起而烘托出的亚微外科，可推动人们进一步达到精准的手术境界。%Minimal invasive surgery (MIS), which is presented by laparoscopy, has developed for more than a quarter of century. More and more surgical operations can be finished by laparoscopy, not only for cholecystectomy, but also for some complex operations, even radical operation for gastrointestinal cancer, such as radical rectectomy, D3 colectomy, D2 gastrectomy. These operations have small incisions only, but with extensive injury and bleeding in the abdomen. Meanwhile, total mesorectal excision (TME) for rectal cancer and complete mesocolic excision (CME) for colon cancer have been proposed by surgeons in the field of open surgery. During those procedures, they suggested that it is very important to find out a “space”, then expand it to a“holly plane”, to achieve resection en bloc and less bleeding , namely “plane surgery”. In fact, the “plane” is consisted of two membranes under laparoscopy, that is the membranes (fascia or serous) which come from the mesentery in broad sense (or tissue bloc) and its bed. Understanding of the membrane anatomy we proposed, which includes the mesentery in broad sense (or tissue bloc) and the mesentery bed, will help the surgeons identify the correct anatomy or plane intentionally or accurately, and perform operations more easily, more precisely with less bleeding, more radically and less side injury. However, It is not easy to identify the membrane anatomy by naked eyes or traditional laparoscopy. It is not only dependent on the development of knowledge of membrane anatomy, but also the instruments developed by industry. Now, it seems to become possible when industry of optic or glass developed some instruments , such as 3D laparoscopy, binocular loupe, which have the proper magnifying power and high density resolution, and can identify the membrane anatomy at macro level (not micro level). Wearing these instruments, based on the membrane anatomy (macro anatomy), the classical operations, which include traditional laparoscopy or open operation , progress from gross surgery to macro surgery. Macro surgery is more precise procedure and between the gross and micro surgery. The merge from clinical practice, basic science and industry results in macro surgery which will lead to a new surgery level.
