Dr. Ai Zhilong, a distinguished alumnus of the former Shanghai Medical University with a Bachelor’s degree in Clinical Medicine, currently serves as the Director of the Thyroid and Breast Surgery Department and the Director of the Day Surgery Ward at Zhongshan Hospital, affiliated with Fudan University in Shanghai.

He holds prominent roles in several prestigious medical organizations, including:

Vice Chair of the Thyroid Surgery Group, Surgical Branch, Chinese Medical Doctor Association

Deputy Secretary-General of the China Day Surgery Alliance

National Committee Member of the Thyroid and Metabolic Surgery Group, Surgical Branch, Chinese Medical Association

National Committee Member of the Thyroid Cancer Committee, Chinese Anti-Cancer Association

National Committee Member of the Bone Metabolism and Parathyroid Diseases Committee, Chinese Research Hospital Association

Vice Chair of the Thyroid Surgery Group, Surgical Branch, Shanghai Medical Association

Dr. Ai specializes in the diagnosis and treatment of thyroid, parathyroid, and neck mass diseases, with particular expertise in lymph node dissection for thyroid cancer with lymphatic metastasis. He is renowned for his skill in performing complex neck surgeries, especially the removal of large thyroid masses. With extensive experience in open surgery, Dr. Ai places significant emphasis on postoperative recovery and the prevention of complications, ensuring comprehensive patient care.

Prologue

Reflecting on my first encounters with him in 2016 and 2019, he had already mastered exceptional medical skills and possessed unwavering determination. Now, with the passage of time, he has gained even more experience and achievements, finding balance and tranquility amidst his busy schedule. He often says that a doctor’s duty is not only to treat illnesses but also to provide patients with emotional comfort and support. In every surgery and every outpatient visit, he pours in his most sincere emotions and professional expertise.

Over the years, his surgical workload has continued to grow, from 1,300 procedures in 2019 to nearly 2,000 in 2024. While this keeps him fulfilled, it also brings occasional exhaustion. He smiles and remarks, “Persisting through pain and joy is no easy feat.”

Today, he remains on the frontlines, fulfilling his promises through action—whether it’s early morning outpatient sessions or late-night surgeries, he gives his all. In this era of challenges and hope, he persists and pioneers with unwavering dedication. Time has left its marks on him, but it has also endowed him with profound depth and steadfast conviction.

“Choosing to be a doctor means preparing yourself for countless challenges and hardships. But if you persevere, you’ll gain boundless fulfillment and inner satisfaction. Once you’ve chosen, worked hard, persisted, and walked the path, you can look back without regret. A doctor’s life is not easy, but as you grow older, you’ll gradually understand.”

“‘Glory is like dew on flowers, wealth is like frost on grass.’ In the quiet persistence, seek the ease of drifting clouds and the freedom of flowing water—perhaps this is the attitude life should embody.”

Now, he places greater emphasis on the growth of his team and firmly believes that the future belongs to the younger generation. He often advises young doctors that endurance and perseverance are the greatest tests in this profession. In this field of immense responsibility, what’s needed is not only wisdom and skill but also a heart of selfless dedication.

Growing with the Times

“We are a remarkable nation, having solved the healthcare needs of the majority with limited resources—no easy feat. Over the years, the number of patients in our thyroid and breast surgery department has increased, both in early and advanced stages, and cases have become more complex. As doctors, we must work harder, fulfill our responsibilities, and provide better services to meet these new challenges.”

Over the past five years, Dr. Ai Zhilong has encountered an increasing number of complex and rare cases, witnessing unforgettable medical scenarios. He has come to realize that the spectrum of thyroid tumors may be undergoing changes. “This trend reflects shifts in societal health conditions and places higher demands on us. The progress of our profession lies in continuously facing these challenges and moving forward.”

Recently, Dr. Ai encountered a patient in his forties with anaplastic thyroid cancer, a stark contrast to the so-called “lazy cancer” often described in textbooks. The rapid progression of the disease left Dr. Ai deeply shocked. The patient told him, “Dr. Ai, I can feel the tumor moving from my right side to the left.” It was an extremely rare case in Dr. Ai’s career for a patient to sense the tumor’s movement so vividly. Increasingly complex cases often require more meticulous surgeries and pose greater technical challenges for doctors.

In recent years, Dr. Ai has frequently shared new surgical techniques and experiences in treating difficult cases at academic conferences, enriching both his professional and personal life. While thyroid surgeries are typically elective, emergencies do arise, such as when a tumor compresses the trachea, causing breathing difficulties. Dr. Ai’s team has employed ECMO (extracorporeal membrane oxygenation) technology to handle such critical situations. “Due to the severe narrowing of the patient’s trachea, conventional intubation methods were impossible. Without timely surgery, the patient’s survival chances would have been slim. Fortunately, with the multidisciplinary collaboration and advanced technology at our comprehensive hospital, we successfully performed the surgery, achieving a historic breakthrough.”

As a surgeon with decades of experience, Dr. Ai continually seeks breakthroughs in surgical techniques. Four years ago, a lecture inspired him to refine his surgical approach. “Four years ago, during a lecture, I realized that the traditional midline neck incision, while classic, might not be the best option,” Dr. Ai recalled.

He noted that the traditional incision, advocated by Emil Theodor Kocher, the 1909 Nobel Prize winner in Medicine, has been used for over a century. Although effective, this incision damages the anterior neck functional area, affecting patients’ postoperative quality of life. “I realized that while this incision is classic, it is not ideal for cosmetic outcomes or functional preservation,” Dr. Ai explained.

Dr. Ai decided to innovate by adopting the supraclavicular incision. This approach offers several advantages, most notably better cosmetic results. The supraclavicular incision is made in the supraclavicular fossa, a softer area that minimizes scarring. Additionally, it can be easily concealed by ordinary round-neck clothing, reducing patients’ discomfort. “Think about it—with a supraclavicular incision, a round-neck shirt can cover it completely,” Dr. Ai said with a smile.

Beyond aesthetics, the supraclavicular incision better preserves the anterior neck functional area. The traditional midline incision often severs nerves in this region, causing postoperative swallowing discomfort. The supraclavicular incision avoids this area, enhancing patient comfort.

Dr. Ai’s innovation has benefited many patients, including complex cases. One patient, who returned from Canada, had a particularly challenging surgery. Dr. Ai used three incisions—one on each side of the lower neck and one under the jaw—while protecting the central functional area with the supraclavicular incision. “The patient’s tumor was large and complex, but with this refined approach, we resolved the issue while preserving his functionality as much as possible,” Dr. Ai explained.

This innovation has shown significant results in both cosmetic and functional preservation, with broad surgical applicability. Dr. Ai stated that the supraclavicular incision can be used in 80% to 90% of thyroid surgeries, including bilateral central lymph node dissection and partial lateral neck dissection. “Essentially, 90% to 95% of cases can be completed with this incision,” he said.

Despite the widespread recognition of this approach, Dr. Ai believes there is still room for improvement and further research. He hopes future clinical studies will quantitatively assess the benefits of this incision, providing scientific evidence to benefit more patients.

In His Own Words

“Choosing to be a doctor means preparing yourself for countless challenges and hardships. But if you persevere, you’ll gain boundless fulfillment and inner satisfaction. Once you’ve chosen, worked hard, persisted, and walked the path, you can look back without regret. A doctor’s life is not easy, but as you grow older, you’ll gradually understand.”

“‘Glory is like dew on flowers, wealth is like frost on grass.’ In the quiet persistence, seek the ease of drifting clouds and the freedom of flowing water—perhaps this is the attitude life should embody.”

Now, Dr. Ai places greater emphasis on the growth of his team and firmly believes that the future belongs to the younger generation. He often advises young doctors that endurance and perseverance are the greatest tests in this profession. In this field of immense responsibility, what’s needed is not only wisdom and skill but also a heart of selfless dedication.

“Perhaps I Can Improve the Quality of Life for Dialysis Patients”

In recent years, Dr. Ai Zhilong has been focusing on parathyroid issues in dialysis patients. He hopes that through his efforts, he can revise the current guidelines for thyroid surgery in dialysis patients, thereby benefiting more individuals. “Secondary hyperparathyroidism (SHPT) is a common complication in patients with chronic renal failure,” Dr. Ai explained. This complication arises from abnormal calcium and phosphorus metabolism in the body, often leading to symptoms such as bone pain and skin itching. More severely, it can cause vascular calcification, increasing the risk of cardiovascular and cerebrovascular accidents, which can be life-threatening.

“Many long-term dialysis patients develop these symptoms after a few years. I believe our country has the ability to change this situation.” With advancements in medicine and improvements in living standards, patients with chronic renal failure are now able to extend their survival and enhance their quality of life through long-term dialysis. However, dialysis-related complications, particularly secondary hyperparathyroidism, are also on the rise. Many long-term dialysis patients suffer from varying degrees of SHPT.

For patients requiring surgical intervention, the most commonly used procedure is total parathyroidectomy with autotransplantation of parathyroid tissue into the forearm. This approach effectively reduces parathyroid hormone levels, and most patients see their hormone levels return to normal post-surgery. Additionally, conditions such as hypercalcemia and hyperphosphatemia gradually improve, significantly alleviating symptoms like bone pain and itching, and reducing vascular calcification, thereby enhancing patients’ quality of life and survival time.

However, Dr. Ai questions the existing surgical guidelines. According to current guidelines, surgery is only recommended when a patient’s parathyroid hormone levels exceed 800 pg/ml. Dr. Ai believes this threshold can be further refined. “Why must we wait until levels exceed 800 pg/ml to perform surgery?” Dr. Ai asked. “It pains me to see patients with such large calcified nodules. If we operated at 500 pg/ml, could we reduce their suffering and improve their quality of life? Some countries recommend surgery at levels above 300 pg/ml. Why can’t we take action at 500 pg/ml?”

The survival time of dialysis patients has significantly increased, and so has their demand for a better quality of life. Today, the Healthy China 2030 initiative emphasizes “early detection, early diagnosis, and early treatment,” and uremic patients should also benefit from such early interventions. “Improving the quality of life for uremic patients is crucial. If we can perform surgery earlier, we can not only reduce their suffering but also save significant medical costs. From a health economics perspective, this approach is highly worthwhile.”

Dr. Ai is particularly eager to conduct more clinical research to demonstrate the benefits of this refined approach. “What I feel is most important now is to conduct a clinical study to quantify these benefits. Only then can we convince more experts and peers to revise the current surgical guidelines.”

Trees Make a Forest, Drops Make an Ocean

In addition to his continuous innovations in surgical techniques, Dr. Ai Zhilong places great emphasis on team development. “As the department director and Party branch secretary, I’m 54 years old now. I always believe that young people are more capable and energetic, and I hope to nurture them into even more outstanding doctors.”

In recent years, Dr. Ai led the establishment of the independent Thyroid and Breast Surgery Department, which was separated from the general surgery department. His role now extends beyond performing surgeries to considering talent development and the potential of each team member.

“To unleash everyone’s potential, relying on one person alone is not enough,” Dr. Ai said. While he is highly experienced in open surgeries, he feels less confident in endoscopic thyroid surgeries. Over the years, perhaps due to overwork, he unfortunately developed diabetes and noticed a decline in his physical and visual endurance. For emerging endoscopic techniques, Dr. Ai encourages young doctors to explore and learn, mastering these new technologies. Today, several young members of the department have begun performing endoscopic thyroid surgeries with excellent results.

As a mentor, Dr. Ai often leads by example. He believes that beyond honing medical skills, it is crucial to cultivate in young doctors the ability to discern right from wrong, maintain a scientific attitude, and remain flexible in handling various situations.

With technological advancements, the ways doctors and patients communicate have also diversified. Dr. Ai has always been attentive to the development of internet-based healthcare, viewing it as a significant trend in medical services. “The internet has brought us tremendous convenience,” he emphasized. “I often use it to serve more patients, which greatly improves efficiency.” Since joining an online consultation platform, Dr. Ai has received inquiries from patients across the country. “Patients in the northeast can now schedule appointments and consult online in advance. This not only enhances diagnostic efficiency but also reduces their travel burden, making it more convenient for them. This is truly gratifying.”

Dr. Ai is full of confidence in the future. He hopes that through the collective efforts of the team, the department’s professional standards can be further elevated to better address complex thyroid diseases. “I hope every young member of our department can refine their existing skills, keep learning, and embrace future challenges,” he said.

In Dr. Ai’s view, medicine is not like mathematics—it cannot remain static. When formulating guidelines and executing plans, it is essential to consider not only the scientific aspects of medicine but also the actual conditions and needs of patients. Only then can doctors truly excel in their work, bringing more hope and warmth to patients. And he, with his selflessness and dedication, has added a warm touch to the medical endeavors of his department.

ShanghaiDoctor.cn

Doctor Ai, your work intensity is very high. How do you balance the demands of such a rigorous schedule with your personal health?

Dr. Ai Zhilong

 

I’m 54 years old now, and my physical condition is indeed not as good as before, especially since I have diabetes, which has also affected my eyesight. However, I still try my best to maintain a balance between work and life. I regularly go to the hospital’s health check-up center for comprehensive examinations to stay informed about my health. I also make an effort to engage in health-preserving activities outside of work, such as taking daily walks and doing moderate exercises. Additionally, I manage my rest time reasonably, trying not to stay up late and ensuring I get enough sleep.

Certainly, the intensity of work is indeed very high, especially since I’m not only performing surgeries but also managing departmental and Party branch affairs. To cope with this, I rely more on the strength of the team, nurturing young doctors and enabling them to take on more responsibilities in surgeries and诊疗. Additionally, I make the most of the convenience of the internet by using online platforms for remote consultations. This helps save time and reduces the pressure of face-to-face interactions. The internet truly makes me feel highly efficient.

ShanghaiDoctor.cn

What are some of your unfulfilled dreams and plans?

Dr. Ai Zhilong

 

Speaking of dreams, I do have some unfulfilled ones. What I care about the most is to develop a new perspective and propose innovative treatment approaches for parathyroid diseases in uremic patients within my lifetime. These patients are among the most vulnerable in society, as they undergo long-term dialysis, which significantly impacts their quality of life. If we could implement a new method where surgery is performed when their levels reach 500 pg/ml instead of waiting until 800 pg/ml, it could prevent many complications and greatly improve their quality of life. Achieving this dream is indeed challenging—it requires extensive clinical research and the collaborative support of multiple hospitals. I’ve even considered funding some preliminary research myself. Although I sometimes feel overwhelmed, I remain determined to persevere. After all, a doctor’s duty is to seek the well-being of patients, and being able to help these individuals and their families holds immense significance.

ShanghaiDoctor.cn

Doctor Ai, what is your perspective on the phenomenon of patients self-diagnosing through the internet, and how should doctors respond to it?

Dr. Ai Zhilong

 

This issue is indeed very common. Nowadays, many people obtain medical information through the internet, and sometimes even attempt to self-diagnose. I think this phenomenon has both positive and negative aspects. On the positive side, the internet allows patients to better understand their conditions and seek help earlier. However, on the negative side, many patients lack a medical background and can easily misinterpret information, either frightening themselves or delaying proper treatment. I often encounter this in my clinic—some patients read something online and become extremely anxious, convinced they have a certain illness. I always take the time to patiently explain to them, advising them not to worry excessively, as medicine is complex and not that straightforward. I often say, “Non-medical professionals delving into medical details may only end up causing themselves unnecessary distress.”

ShanghaiDoctor.cn

Doctor Ai, finally, could you offer some advice to young doctors and medical students?

Dr. Ai Zhilong

 

I believe this is very important. First and foremost, it is essential to have a solid medical foundation and avoid seeking quick success. Medicine is a science that requires a rigorous attitude and solid skills. I always tell my students to follow the example of my own teachers—to impart knowledge through both words and actions, to clarify principles, and to maintain a scientific approach. Secondly, continuous learning and improvement are crucial. Medical technology is advancing rapidly, with new treatment methods and concepts constantly emerging. Young people must keep up with the times by actively participating in academic conferences and training to master the latest techniques. For example, although I can no longer perform endoscopic thyroid surgery due to health reasons, young doctors should study and practice more to refine this technique. Third, teamwork is vital. An individual’s strength is limited, and only through collaboration can we better tackle complex diseases. As the department head, I not only perform surgeries myself but also focus on nurturing more talent, enabling everyone to leverage their strengths. This way, the overall level of the department can be elevated. Finally, effective doctor-patient communication is essential. Some patients may develop misunderstandings due to misinformation on the internet, so doctors must be patient, using warm language and a compassionate attitude to alleviate their anxiety and help them correctly understand their condition. It’s also important to introduce them to the “uncertainties” in medicine, as this fosters true alignment between doctors and patients.

Interview/Gong Zhiwei     Editor/Chen Qing

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