Anatomical Variations Of Cystic Artery: Telescopic Facts
- Author:
Muhammad Zubair
;
Lubna Habib
;
Masoom Raza Mirza
;
Muhammad Ali Channa
;
Mahmood Yousuf
;
Muhammad Saeed Quraishy
- Publication Type:Journal Article
- From:
The Medical Journal of Malaysia
2012;67(5):494-496
- CountryMalaysia
- Language:English
-
Abstract:
The introduction of laparoscopic cholecystectomy has
stimulated a renewed interest in the anatomy of Calot’s
triangle 1. This triangle is a focal area of anatomical
importance in cholecystectomy and a good knowledge of its
anatomy is essential for both open and laparoscopic
cholecystectomy 2, 3. This triangle was described by Calot in 1891 as bounded by the cystic duct, the right hepatic duct and lower edge of liver 4. In its present interpretation the upper border is formed by the inferior surface of the liver with the other two boundaries being the cystic duct and the common hepatic duct 2,5. Its contents usually include the right
hepatic artery (RHA), the cystic artery, the cystic lymph node (of Lund), connective tissue and lymphatics 5,6. The cystic artery is a branch of the RHA and is usually given off in Calot’s triangle 7.
Anatomic variations in Calot’s triangle are common.
Variations in cystic artery anatomy, based on its origin,
position and number are well described 3, 8 because of its
importance in avoiding inadvertent bleeding and its
consequences. The reported incidence of these variations is
from 25 to 50 % in various studies 3,9 with the magnified
laparoscopic view having increased the frequency of
recognition of these variations. The methods of retraction
used in the laparoscopic procedure gives a different view of the area, thus introducing the term ‘laparoscopic anatomy’7.
Accurate knowledge of cystic artery anatomy and its
variations can reduce the likelihood of uncontrolled intraoperative bleeding, an important cause of iatrogenic extra hepatic biliary injury and conversion to open
cholecystectomy 3, 7, 8. The incidence of conversion to open surgery due to vascular injury is reported to be 0-1.9% and its mortality 0.02% 3, hence these variations should stay in surgical conscience to prevent procedure related morbidity.
We aim to present the variations in cystic artery seen in
laparoscopic cholecystectomy in our patient population.
