Founder | Surgical Pioneering Newsletter and Podcast Series
Editorial Board Member | Genesis Journal of Surgery and Medicine
The Menopause Scandal That Affects Millions is a shocking revelation that sheds light on the often misunderstood and stigmatized topic of menopause. As women's health continues to be a pressing concern, it is essential to address the menopause scandal that affects millions of women worldwide. Menopause awareness is crucial, and it is high time we break down menopause myths and delve into the symptoms explained by medical experts. Hormone therapy, including hormone replacement therapy, is a common solution for women experiencing night sweats, hot flashes, and hormonal imbalance. However, the menopause scandal highlights the need for better menopause support and education, not just for women but also from a men's perspective. Understanding what is menopause, its causes, and what causes hot flashes is vital in providing adequate menopause solutions. The menopause journey can be challenging, but with the right approach to menopause issues, women can find relief from symptoms of menopause. This video aims to spark a conversation about the menopause scandal, promoting menopause awareness and providing valuable insights into women's health, particularly in the context of perimenopause and hormone therapy. By exploring the complexities of menopause, we hope to empower women with the knowledge they need to take control of their health and well-being.
To access additional details, please refer to the Surgical Pioneering Podcast Series application available at the following link:
Founder | Surgical Pioneering Newsletter and Podcast Series
Editorial Board Member | Genesis Journal of Surgery and Medicine
- Published online: 13 October 2025
- Citation: Luque Villalobos E et al. BMJ Open 2025;15:e100518.
1. Overview
The LIVERATION trial is a prospective, international, multicentre, single-blind, parallel-group, randomised clinical trial (RCT) funded by the Horizon Europe Programme (Grant 101104360). It aims to determine whether additional margin coagulation (AMC)—using approved radiofrequency (RF) devices (e.g., Coolingbis®, Aquamantys®)—reduces local recurrence (LR) after liver resection for colorectal liver metastases (CRLM) and hepatocellular carcinoma (HCC).
- Design: 1:1 randomisation across 24 centres in 7 European countries.
- Sample size: 698 patients (518 CRLM, 180 HCC), powered to detect absolute reductions in LR of 6.9% (CRLM: 10.2% → 3.3%) and 15.5% (HCC: 20% → 4.5%).
- Primary endpoint: Incidence of LR within 3 years, centrally reviewed on standardized imaging.
- Secondary endpoints: Overall survival (OS), disease-free survival (DFS), cancer-specific survival, complications (Clavien-Dindo/CCI), and quality of life (EORTC QLQ-C30/HCC18).
- Follow-up: 30/90 days, then annually up to 3 years.
- Trial registration: NCT05492136.
The trial builds on earlier retrospective work by the same group, notably Villamonte et al. (2022) , which reported reduced LR with AMC, and Quesada et al. (2017) and Sui et al. (2019) , showing promising signals for RF-assisted transection and Aquamantys®, respectively.
To access additional details, please refer to the Surgical Pioneering Podcast Series application available at the following link:
With a distinguished career spanning 11 to 20 years since earning his medical degree from the University of Chicago's Pritzker School of Medicine, Dr. Rohan Lall has leveraged his extensive clinical expertise to address fundamental challenges in spine surgery. He is affiliated with M Health Fairview University of Minnesota Medical Center and M Health Fairview Southdale Hospital, and holds the strategic leadership role of Chief Medical Officer at SynerFuse, the company developing the innovative procedure bearing its name.
Core Areas of Expertise
• Robotic and Minimally Invasive Surgery
• Complex Spinal Surgery (including conditions like spinal fusion, stenosis, and spondylosis)
• Brain and Spinal Tumor Surgery
• Skull Base and Pituitary Tumor Surgery
Beyond his exceptional clinical skills, Dr. Lall is an innovator who is actively involved in the development of new technologies, most notably his groundbreaking work on a new procedure to treat chronic back pain.
2. The SynerFuse Innovation: A New Hope for Chronic Back Pain
🌟 Overview of the SynerFuse ULE™ Procedure
The SynerFuse ULE™ (Ultra Low Energy) Therapy is an innovative, integrated surgical approach designed to treat chronic low back and leg pain, which is often unaddressed by traditional spinal fusion alone.
Integrated Solution: The patented procedure, formally known as Electric Transforaminal Lumbar Interbody Fusion™ (e-TLIF™), combines two treatments into a single surgery:
Spinal Fusion (e.g., TLIF): To decompress, stabilize, and reconstruct the spine.
Neuromodulation (Direct Nerve Stimulation): To address residual neuropathic pain by altering how the nerve perceives pain.
How it Works: During the spinal fusion surgery, the surgeon implants the fusion hardware and, in the same single incision, places multi-channel electrical leads onto the affected nerves (specifically targeting the Dorsal Root Ganglion - DRG, in some cases). These leads are connected to an implantable pulse generator (NeuroFuse® System).
Goal: The primary goal is to provide preemptive, non-narcotic pain management immediately following spinal fusion, aiming to reduce chronic neuropathic pain and the need for long-term opioid use. Neuropathic pain can occur in up to 40-50% of patients after traditional spinal fusion, even if the fusion is successful.
Dr. Rohan Lall's Role: Dr. Rohan Lall, a neurosurgeon, has been a key figure in the proof-of-concept study for this procedure at M Health Fairview/University of Minnesota, performing one of the first solo SynerFuse implants in a two-level spinal fusion patient.
Current Status: The procedure has completed an initial proof-of-concept study to evaluate its safety and feasibility. The company is now designing and building the NeuroFuse® System in preparation for a larger pivotal clinical trial toward FDA approval.
A significant challenge in spinal surgery is the chronic low back and leg pain that can persist even after a successful spinal fusion procedure. The SynerFuse procedure was developed to address this very problem, offering a new approach for patients whose discomfort continues after traditional surgeries.
2.1. A Dual-Action Approach
The SynerFuse® e-TLIF™ procedure, a form of Ultra Low Energy (ULE™) Therapy, is an innovative technique that combines two powerful therapies into a single, integrated treatment: conventional spinal fusion surgery and targeted nerve stimulation (a practice known as neuromodulation). The goal is to address pain at its source by fundamentally altering the nerve’s ability to transmit pain signals to the brain.
2.2. Dr. Lall's Pioneering Role
Dr. Lall has been central to the development and implementation of this new technology. His specific contributions are a testament to his leadership in the field:
1. Served as an investigator for the SynerFuse Proof of Concept trial.
2. Pioneered the e-TLIF procedure.
3. Performed the world’s first solo SynerFuse e-TLIF procedure.
4. Completed the first-ever 2-level procedure.
2.3. Patient Impact and Future Outlook
This procedure represents a significant advancement in patient-centric care, although it is still in its early stages of evaluation.
Patient Benefits & Experience
Current Status & Outlook
Smartphone Control: Patients can control nerve stimulation.
Promising Initial Results: Early data shows significant benefit.
Significant Pain Reduction: Reported by early trial participants.
Limited Study Group: The procedure has been performed on a limited number of patients.
Improved Quality of Life without Opioid Dependence.
Long-Term Evaluation: Long-term effectiveness is still being actively studied.
This pioneering procedure exemplifies Dr. Lall's commitment to advancing the standards of spinal care by directly addressing the limitations of existing treatments.
3. Conclusion: An Innovator Shaping Spinal Care
Dr. Rohan Lall stands out not only as a highly skilled neurosurgeon but also as a forward-thinking leader shaping the future of his specialty. His active involvement in developing new technologies, particularly the SynerFuse procedure, marks a "significant step forward" in addressing the debilitating challenge of chronic back pain. Dr. Lall's inspiring dedication to enhancing patient health through innovative surgical solutions continues to push the boundaries of what is possible in spinal care.
