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1 and summarized in Table 1, the TPMO framework follows a structured progression: the neoadjuvant phase focuses on surgical optimization, the surgery (core) phase aims for a definitive metabolic reset, and the adjuvant phase is designed for long-term maintenance to prevent metabolic adaptation

Cardiovasc Diabetol 10:62 Lin RC, Scheller RH (2000) Mechanisms of synaptic vesicle exocytosis

Blackman MR, Sorkin JD, Munzer T, Bellantoni MF, Busby-Whitehead J, Stevens TE, Jayme J, OConnor KG, Christmas C, Tobin JD, Stewart JK, Cottrell E, St Clair C, Pabst KM, Harman SM