OBJECTIVE:To evaluate the feasibility and perceived utility of mixed-reality-assisted navigation using patient-specific 3-dimensional holographic models derived from computed tomography in transvaginal surgery for stress urinary incontinence and pelvic organ prolapse. METHODS:Patient-specific computed tomography imaging data were converted into 3-dimensional holographic models using the HoloEyes MD system. The holograms were projected using HoloLens 2 for intraoperative guidance. The study included 24 transvaginal surgeries (tension-free vaginal tape, transobturator tape, transvaginal mesh, and sacrospinous ligament suspension), involving 46 surgeons and assistants. Surgical tools were modeled as spatial reference markers using kneadable erasers and integrated into the mixed-reality visualization system. RESULTS:The mixed-reality system was perceived to improve surgeons' spatial understanding of pelvic anatomy and surgical workflow, particularly in anatomically complex regions such as the sacrospinous ligament and obturator foramen. Most participants reported enhanced anatomical comprehension and perceived usefulness of the system during preoperative planning and intraoperative confirmation. Familiarity with the technology improved with repeated use. CONCLUSION:Mixed-reality-assisted navigation using patient-specific holographic models is feasible in transvaginal procedures and may support surgeons' spatial understanding and confidence during surgery. This technology shows potential as a useful educational and intraoperative support tool in urology and gynecology.
BACKGROUND:Dupuytren contracture is a fibroproliferative disorder that causes progressive flexion deformities of the fingers. Various traditional procedures have distinct benefits and limitations. We developed a novel surgical technique combining selective fasciotomy with local flap interposition to restore extension while preventing pathological reconnection. METHODS:This study adhered to the STROBE guidelines. A retrospective review was conducted on 64 patients (90 fingers; average age, 68.1 years) treated between 2011 and 2024 at two institutions with expertise in hand surgery. Pathological cords were selectively divided through one to three transverse incisions according to the site of contracture. Skin defects were covered with digitolateral or ulnar parametacarpal flaps, which physically interposed between the divided fascial ends. Active extension of the metacarpophalangeal and proximal interphalangeal joints was measured preoperatively and at follow-up visits to assess surgical outcomes and recurrence. RESULTS:All flaps survived and no major complications, such as hematoma, infection, skin necrosis, or neurovascular injury, were observed. At 6 months postoperatively, 90.7% of metacarpophalangeal joints and 61.7% of proximal interphalangeal joints maintained extension within -5° of full extension. Among the 23 fingers followed for more than 2 years, no apparent tendency toward recurrence was observed. CONCLUSIONS:This technique achieved favorable clinical outcomes with minimal complications. Selective division combined with local flap interposition may effectively reduce the risk of fascial reconnection and early recurrence. Further long-term studies are warranted to confirm the durability of these results and refine the indications for this approach.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, Ⅳ.
OBJECTIVES:The impact of the prostatic urethral lift (PUL) on overactive bladder (OAB) symptoms in benign prostatic hyperplasia (BPH) remains insufficiently defined. This study evaluated longitudinal changes in overactive bladder symptom score (OABSS) after PUL and identified clinical factors associated with meaningful improvement. METHODS:This prospective single-center study included 140 men who underwent PUL between May 2022 and April 2025. Symptoms and functional parameters-including International Prostate Symptom Score (IPSS), quality-of-life (QOL) score, uroflowmetry, and OABSS-were assessed at baseline and at 1, 3, and 6 months. OAB was defined as urgency (OABSS Q3 ≥ 2) with total OABSS ≥ 3. Clinically meaningful improvement was defined as a ≥ 3-point reduction in total OABSS. RESULTS:PUL was associated with significant improvement in IPSS, QOL score, Qmax, and PVR at all postoperative time points. Total OABSS decreased from 5.8 to 4.4, 3.9, and 3.7 at 1, 3, and 6 months (p < 0.001), with most improvement observed within 3 months. All OABSS items showed significant postoperative reductions. Patients with preoperative OAB had larger prostate volumes; however, both OAB and non-OAB groups demonstrated postoperative improvement. Clinically meaningful improvement occurred in 45.8%, 55.4%, and 57.8% of patients with preoperative OAB at 1, 3, and 6 months, respectively. Higher baseline OABSS consistently predicted responder status. CONCLUSIONS:PUL was associated with significant and sustained improvement in storage symptoms up to 6 months. Approximately half of men with preoperative OAB achieved clinically meaningful improvement.
Laparoscopic liver biopsy (LLB) provides a way to obtain liver tissue samples under direct visual inspection of the liver surface. It complements percutaneous liver biopsy (PLB) for complex or high-risk cases where PLB cannot be performed. Clinical practices for LLB vary across centers due to the lack of international standards. To improve the procedural quality and diagnostic efficiency of LLB, a multidisciplinary panel of 45 international experts from 6 continents, including hepatology, hepatobiliary surgery, gastrointestinal surgery, and metabolic and bariatric surgery, developed this consensus statement through three rounds of a modified Delphi process. This consensus covers clinical application scenarios, high-risk clinical scenarios, preoperative preparation, surgical procedures, complication management, and discharge and quality management. It aims to promote the standardization, safety, and rational clinical application of LLB; support the management of complex cases; and facilitate the appropriate implementation of this important diagnostic procedure.
