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Abstract: Introduction:Perforation of the gallbladder is a benign and common complication during laparoscopic cholecystectomy. However, it may result in stone spilling, which potentially can lead to serious postoperative complications. Case report:A 70-year-old male underwent laparoscopic cholecystectomy for acute cholecystitis. The procedure was complicated by perforation of the gallbladder and spilling of gallstones. More than a year after the procedure, the patient developed subcutaneous abscesses containing some of the spilled stones, a computed tomography revealed a complex intraabdominal and intrathoracic fistula with communication from the abdominal cavity to pleura and ultrasonic imaging found a lost gallstone in the thorax. After two years, the patient developed pleural empyema and sepsis secondary to the condition. Presently, the patient awaits surgery for the fistula and empyema. Conclusion:Proper care should be taken to avoid stone spilling during laparoscopic cholecystectomy. However, if perforation and stone spilling occur, all visible stones should be removed during the procedure and the complication should be noted in the medical records. Furthermore, the patient should be thoroughly informed. This may help accelerate diagnosis if the patient later suffers from a complication related to lost stones.
Background: Robotic-assisted hysterectomy is increasingly performed using modular platforms such as the Hugo™ robotic-assisted surgery (RAS) system, but optimal or personalised docking strategies remain undefined. Objectives: To establish expert consensus on port placement and docking configurations for hysterectomy with the Hugo™ RAS system and to identify patient anthropometric factors requiring modification of standard setups. Methods: A modified Delphi consensus was conducted involving two iterative rounds of anonymous, structured questionnaires distributed to an international panel of gynaecological robotic surgeons experienced with the Hugo™ RAS system. Survey items addressed preferred docking configurations, the influence of patient anthropometry on docking strategy, and specific technical adjustments in non-standard scenarios. Consensus was predefined as ≥66.7% agreement. Main Outcome Measures: Expert agreement on docking setups, port placement modifications, and anthropometric variables influencing technical adjustments. Results: Seventeen experts completed round one and 16 completed round two. No single docking configuration reached consensus as universally optimal for standard hysterectomy. Ranking exercises identified the “standard” hysterectomy setup as the most preferred configuration, followed by the “alternate” and the “three-arm” setups. All experts agreed that patient anthropometry requires modification of port placement. Elevated body mass index (BMI), large uterine size and small pelvis were identified as key variables: increasing inter-port distance was recommended for BMI >30, cranial port displacement for large uteri, while no consensus emerged for patients with a small pelvis. A modified bridge configuration was proposed, and achieved strong expert agreement. Conclusions: No single docking configuration is deemed to be universally optimal for Hugo™ RAS hysterectomy. Expert practice combines a limited number of preferred setups with patient-tailored adjustments. What is New? This study provides the first Delphi-based expert consensus on Hugo™ RAS docking strategies, emphasizing patient-specific adjustments and flexible preoperative planning.
Smoking and obesity are associated with risk of hidradenitis suppurativa, and both are considered important environmental risk factors. However, a causal relationship remains unproven. To primarily investigate the relationship between body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) and smoking and HS, and secondarily to investigate potential relationships between 3 inflammatory diseases (psoriasis, inflammatory bowel disease [IBD], and systemic sclerosis [SSc]) and HS. A mendelian randomization (MR) study conducted in 2024 on 5 exposure phenotypes (BMI, smoking, psoriasis, IBD, and SSc) on the outcome of phenotype HS was conducted. The MR analyses used large genetic White European cohorts from genome-wide association studies (GWAS) of each of the 6 phenotypes. Initial analyses were conducted May, 2024, and were updated in May, 2025. The 5 exposure phenotypes using predetermined genome-wide significant single-nucleotide variants as proxies for each particular exposure. The GWAS on HS included 4814 case patients and more than 1.2 million controls from Denmark, Iceland, Finland, the UK, and the US. The BMI GWAS involved 700 000 individuals from the UK Biobank and GIANT consortium. Smoking data were obtained from 1.23 million participants in an international consortium. The psoriasis GWAS analyzed 39 498 case patients and 286 769 controls from White European populations and a DNA genetic testing company. The IBD GWAS meta-analysis included 38 155 case patients and 48 485 controls from the International Inflammatory Bowel Disease (IBD) Genetics Consortium. The SSc GWAS included 9095 case patients and 17 584 controls from White European populations. Genetic correlations ( r g ) were found between HS and all exposure phenotypes except SSc (BMI: r g = 0.36, P < .001; smoking: r g = 0.33, P < .001; IBD: r g = 0.25, P < .001; psoriasis: r g = 0.34, P < .001; SSc: r g = 0.33, P = .22). MR analyses supported an effect of BMI on HS (β = 0.87; odds ratio [OR] per BMI unit, 1.20; 95% CI, 1.17-1.23; P < .001) without signs of pleiotropy (slope: β = 0.91, P < .001, P for intercept = .76). Smoking showed a significant causal estimate (β = 0.59, P < .001), but results became inconclusive in subsequent sensitivity analyses. Among IBD, psoriasis, and SSc, results supported a causal effect of IBD on HS (β = 0.18, OR = 1.20; 95% CI, 1.15-1.24; P < .001), without signs of pleiotropy. These findings indicate causal effects of IBD and increased BMI on the risk of HS. This information may help physicians inform patients about disease risk contributed by modifiable lifestyle behaviors, which can be beneficial for planning lifestyle interventions.
Abstract Study question Is progesterone on blastocyst transfer day associated with live birth rate (LBR) in modified natural cycle frozen embryo transfer (mNC-FET) without luteal phase support (LPS)? Summary answer In mNC-FET without LPS, progesterone on the day of blastocyst transfer was associated with LBR in the crude, but not in the adjusted, regression analyses. What is known already Whether LPS should be routinely administered in mNC-FET remains debated. A recent large, randomised controlled trial (RCT) found no effect of LPS on LBR. However, it is unclear whether certain subgroups, such as women with low serum progesterone on the day of blastocyst transfer, might benefit. This study examines the association between serum progesterone on transfer day and live birth in mNC-FET without LPS, to guide whether future trials of targeted LPS in women with low progesterone are warranted. Study design, size, duration The study included 677 women undergoing single, autologous blastocyst transfer in the mNC-FET protocol without LPS. Data were collected prospectively from 2019-2025 as part of two large multicenter RCTs (The FET Optimizing and FET Immediate trials). Serum progesterone was measured on the day of blastocyst transfer, either six (n = 476) or seven (n = 201) days after hCG trigger. Participants/materials, setting, methods The association between serum progesterone and live birth was assessed using crude and adjusted logistic regression models, the latter adjusting for female age, BMI, AMH, and RCT. Progesterone was analysed as both a continuous and a categorical variable. For the categorical analysis, progesterone levels were classified as ‘low’ or ‘normal–high’ based on the 25th percentile on the day of transfer. Sensitivity analyses were performed excluding mNC-FET cycles conducted in the cycle immediately after oocyte retrieval. Main results and the role of chance The mean (SD) age of included women was 33.0 (4.1) years. Serum progesterone on the day of blastocyst transfer had a median (IQR) of 38.6 (29.5-54.0) nmol/L and a mean (SD) of 44.1 (23.6) nmol/L. The 25th percentile for the whole cohort was 29.5 nmol/L, with day 6 and 7 transfer 25th percentiles at 28.1 nmol/L and 33.6 nmol/L, respectively. In crude analyses, each 1 nmol/L increase in progesterone was associated with slightly higher odds of live birth (OR 1.02, 95% CI 1.01–1.03), and patients with progesterone ≤25th percentile had lower odds of live birth than those above the 25th percentile (OR 0.59, 95% CI 0.38–0.91). After adjustment for female age, BMI, AMH, and RCT, these associations were no longer statistically significant for continuous progesterone (OR 0.99, 95% CI 0.98–1.01) or progesterone below 25th percentile versus above (OR 0.96, 95% CI 0.55–1.69). Sensitivity analyses excluding immediate cycles showed similar results. Limitations, reasons for caution Despite the large sample size, the study may be underpowered to detect small effects, and residual confounding cannot be excluded. As the study population was relatively young, the results may differ in older IVF populations and should not be extrapolated to cohorts of higher age. Wider implications of the findings These results do not support routine measurement of serum progesterone on the day of blastocyst transfer or intervention based on a specific progesterone cutoff. However, targeted LPS in selected subgroups, such as women with very low progesterone, warrants further investigation in sufficiently powered, prospective studies. Trial registration number Yes
Introduction The optimal treatment target for Crohn’s disease (CD) is unknown. Targeting transmural healing (TMH) may be associated with a lower risk of complications than clinical and endoscopic outcomes. The Study to Evaluate Transmural Healing as a Treatment Target in Crohn’s Disease (VECTORS) aims to investigate TMH as a potential treatment target and its long-term benefits in patients with CD.Methods and analysis VECTORS is a phase 4, interventional, parallel-group, multicentre, randomised controlled trial. Approximately 304 adult patients with moderately to severely active CD from multiple international sites will be enrolled and randomly assigned in a 1:1 ratio to treatment target group 1 (corticosteroid-free intestinal ultrasound-based response or TMH plus clinical and biomarker remission) or group 2 (corticosteroid-free clinical and biomarker remission). All patients receive vedolizumab according to the standard dosing regimen, with an additional dose at week 10, followed by a treatment escalation algorithm to reach the assigned targets. Randomisation will be stratified by prior advanced therapy exposure, disease location and disease duration. The primary objective is to determine if treatment target group 1 is superior to group 2 for the primary efficacy outcome of corticosteroid-free endoscopic remission at week 48. CD-related complications (key secondary outcome) are assessed at week 96.Ethics and dissemination The trial is conducted in compliance with the protocol and applicable regulatory requirements and is approved by institutional review boards/independent ethics committees at the country or site level. Patients’ written informed consents are obtained and documented prior to trial participation. Findings will be disseminated in peer-reviewed journals and at scientific congresses.Trial registration numbers NCT06257706; EUCT, 2023-509096-16-00.
