Virginia Mason Medical Center, founded in 1920, is a private, non-profit organization located in Seattle, Washington, US.
This article and accompanying video provide a comprehensive workflow for incorporating headset-mounted augmented reality (AR) navigation for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Consecutive patients undergoing a single level MIS-TLIF with AR navigation for degenerative spondylolisthesis were analyzed between January 2023–2025. Demographic, intraoperative, and postoperative outcomes were collected. The AR workflow features a wireless headset with projection of intraoperative navigation in the surgical field. MIS pedicle screw placement, facetectomy, disc preparation, and contralateral arthrodesis are carried out percutaneously though single line of sight using navigated instruments. A total of 138 consecutive patients underwent AR-assisted spinal fusion at our institution and 22 cases of single-level MIS TLIF met inclusion criteria. Mean age was 62.3 ± 15 years, 59
BACKGROUND:The "difficult gallbladder" in acute cholecystitis can preclude safe achievement of the critical view of safety, prompting subtotal cholecystectomy (STC) as a guideline-supported bailout. We performed a contemporary synthesis to clarify STC's safety effectiveness trade-offs vs total cholecystectomy (TC) and delineate technique-specific outcomes and patient factors that may influence risk. METHODS:We conducted a systematic review and meta-analysis of studies from 2010 to June 2025. Three comparisons were evaluated: (i) single-arm outcomes after STC, (ii) STC vs TC, and (iii) fenestrating STC (f-STC) vs reconstituting STC (r-STC). Random-effects models were applied, with prespecified subgroup analyses, leave-one-out sensitivity analyses, and exploratory meta-regression. RESULTS:In single-arm analysis, bile duct injury (BDI) occurred in 0.3%, bile leak in 13.5%, retained stones in 6.1%, and overall complications in 24.7% of patients. Readmission and reoperation occurred in 17.8% and 6.3%, whereas mortality was 0.8%. Postprocedural endoscopic retrograde cholangiopancreatography (ERCP) occurred in 16.2%, and percutaneous drainage in 5.7%. Compared with TC, STC had significantly higher bile leak, retained stones, overall complications, readmission, reoperation, and ERCP, with no significant difference in mortality, intensive care unit admission, or length of stay (LOS). Meta-regression linked diabetes with higher leak, complications, and ERCP, and male sex with higher surgical site infection. f-STC had significantly higher bile leak and longer LOS than r-STC, with ERCP trending higher. CONCLUSION:STC carries a very low BDI rate, but higher postoperative morbidity and secondary interventions than TC. r-STC demonstrated superior outcomes to f-STC. Diabetes and male sex were important risk modifiers. STC remains a rational bailout when the critical view cannot be achieved.
PURPOSE:The Medtronic implantable tibial neuromodulation system is a leadless, rechargeable, minimally invasive option intended to treat the symptoms of urge urinary incontinence (UUI), a common condition that significantly impairs quality of life. TITAN 2 is a pivotal study evaluating safety and effectiveness of the Medtronic implantable tibial neuromodulation system. The results through 12 months are reported. MATERIALS AND METHODS:This prospective, multicenter, single-arm investigational device exemption study enrolled eligible overactive bladder subjects with UUI. The primary end point was the percentage of subjects who had ≥ 50% reduction in UUI episodes/day after 6 months. Safety was characterized as the rate of adverse device effects (ADEs). Data are reported as mean ± SD or with 95% CIs. RESULTS:Of 126 implanted subjects, 95% were female, the mean age was 63 ± 14 years, and BMI was 35 ± 9 kg/m2. The primary objective was met with 59% of subjects achieving ≥ 50% improvement in UUI episodes/day (95% CI: 49%-67%, P < .0001) at 6 months; at 12 months, 61% had ≥ 50% improvement. Change from baseline was statistically significant at 6 months for UUI episodes/day, voids/day (in urinary frequency subjects), and Urgency Perception Score, with improvements in all 3 symptoms maintained through 12 months. Twenty percent of subjects experienced ADEs through 12 months; 1 ADE was serious and was recovered/resolved. CONCLUSIONS:TITAN 2 met the primary and all secondary objectives by showing a statistically significant improvement of UUI, urinary frequency, and urgency symptoms. Clinical benefits and a favorable safety profile were maintained through 12 months.
Local failure and leptomeningeal disease (LMD) are both poor outcomes that can occur after resection and post-operative radiosurgery for newly diagnosed brain metastases (BM). There is increasing utilization of collagen-embedded Cesium-131 brachytherapy (GammaTile®) as a method of providing immediate adjuvant radiation therapy. Post-operative LMD rates following GammaTile implantation for newly diagnosed BMs has yet to be reported. The objective was to evaluate the incidence of LMD rates, local control (LC), and survival following resection and GammaTile for newly diagnosed BMs. An ongoing, multicenter, prospective, observational Phase IV non-interventional registry (NCT0442738) was queried to analyze rates of LMD following surgical resection of newly diagnosed BMs. Following resection and GammaTile implantation, we evaluated LMD rates, LC, and overall survival (OS). The Kaplan-Meier method was used to analyze time-to-event outcomes. Fifty-one patients with 55 BMs were analyzed. The median follow-up was 12.4 months. The majority of BMs were in the supratentorial brain (87.3
Background and Aims: Gastric outlet obstruction (GOO) is a clinical manifestation of mechanical obstruction at the antropyloric region or proximal small bowel. The goal of endoscopic management is to relieve the obstruction so patients can resume per oral intake. Most studies have focused on malignant causes of GOO; yet only a handful have explored outcomes related to benign etiologies. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a novel method to bypass the obstruction with a lumen apposing metal stent. In this systematic review and meta-analysis, we aim to explore the technical and clinical success of EUS-GE for benign GOO. Methods: Multiple databases were searched for studies looking at EUS-GE for benign GOO from inception until July 2024. The primary outcome was technical and clinical success. Secondary outcomes included rates of reintervention and adverse events (AE). Results: Ten studies met inclusion criteria (n=181 patients). The most common etiologies were from chronic (n=48) and acute (n=41) pancreatitis followed by peptic strictures (n=19) and surgical anastomotic strictures (n=13). The mean procedure time was 66 minutes. The pooled rate of technical success was 95% (95% CI: 87.34-98.16; I 2=0%). The pooled rate of clinical success was 90.6% (95% CI: 81.1-95.4; I 2=0%). Total adverse events and reintervention rates were 11% (95% CI: 6.06-22.33; I 2=38.7%) and 7% (95% CI: 2.23-20.95; I 2=35.9%), respectively. Conclusion: The results of this meta-analysis demonstrate the efficacy and relative safety profile of EUS-GE for benign GOO. Further studies are needed to determine the optimal patient selection related to clinical success based on the underlying etiology.
