scholarly journals Artery to Cystic Duct: A Consistent Branch of Cystic Artery Seen in Laparoscopic Cholecystectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Arshad Rashid ◽  
Majid Mushtaque ◽  
Rajandeep Singh Bali ◽  
Saima Nazir ◽  
Suhail Khuroo ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Cystic Duct ◽  
Cystic Artery ◽  
Branching Pattern ◽  
Accurate Identification ◽  
Calot’S Triangle ◽  
Arterial Bleeding ◽  
Bile Duct Damage

Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47%) patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot’s triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries.

scholarly journals Cystic vein: a guide for safer laparoscopic cholecystectomy

2017 ◽  
Vol 4 (10) ◽  
pp. 3238
Author(s):  
Debasish Samal ◽  
Rashmiranjan Sahoo ◽  
Sujata Priyadarsini Mishra ◽  
Krishnendu B. Maiti ◽  
Kalpita Patra ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Injury ◽  
Cystic Duct ◽  
Cystic Artery ◽  
Anatomic Landmark ◽  
Complications Of Laparoscopic Cholecystectomy ◽  
Constant Feature ◽  
The Relationship

Background: Major complications of laparoscopic cholecystectomy are bleeding and bile duct injury, and it is necessary to clearly identify structures endoscopically to keep bleeding and injury from occurring. The aim of this study was to depict the anatomic landmark in the Calots triangle, a vein (cystic vein), a constant feature which can help Laparoscopic surgeons to conduct a safe LC along with other precautions to be adopted. Methods: A total of 100 patients (58 male, 42 female) who underwent cholecystectomy were examined preoperatively by clinically. The origin and number of cystic veins and their relationship with the Calot triangle was evaluated. Results: The cystic veins were delineated intraoperatively in 80 of the 93 patients. The relationship between the cystic vein and the Calot triangle was identified in 80 (86.02%) of the 93 patients. One cystic vein was found in 53 (66.25%) patients, while multiple cystic veins were found in 27 (33.75%) patients. All these veins are above the cystic common bile duct junction. Conclusion: The configuration of the cystic veins and their relationship in the Calot triangle with cystic artery and cystic duct can be identified intraoperatively and used as a guideline for safe laparoscopic cholecystectomy. 

scholarly journals CYSTIC ARTERY VARIATIONS IN LAPAROSCOPIC CHOLECYSTECTOMY

1969 ◽  
Vol 6 (1) ◽  
pp. 714-717
Author(s):  
MUHAMMAD HUSSAIN ◽  
ADNAN BADAR ◽  
MANZOOR ALI ◽  
SHAHID ALAM ◽  
NAIK ZADA ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Hepatic Artery ◽  
Cystic Duct ◽  
Gold Standard ◽  
Cystic Artery ◽  
Common Hepatic Artery ◽  
Hepatic Parenchyma ◽  
Right Hepatic Artery ◽  
Calot’S Triangle

BACKGROUND: Lap cholecystectomy is gold standard for cholelithiasis. Earlier the incidence ofmorbidity and mortality was higher. Later on with the understanding of anatomy and fine techniquesboth morbidity and mortality decreased. Understanding of the anatomy of calot’s triangle reduces thecomplications of the procedure.OBJECTIVE: To study the pattern of variations in cystic artery and comparison with Caucasians.MATERIAL AND METHODS: All laparoscopic cholecystectomies performed in Shah MedicalCentre,over a period of 1 year from January 2013 to December 2013,in whom detailed anatomy ofcalot’s triangle was clearly displayed were included in the study. Those laparoscopic cholecystectomiesin whom the detailed anatomy was not clear were excluded from the study.Laparoscopic cholecystectomies were performed under general anesthesia. The anatomy of cystic arteryand its branches were identified, and it was also correlated in relation to cystic duct and common hepaticduct.We performed 240 lap cholecystectomies over a period of 1 year from January 2013 to December 2013.RESULTS: The pattern of cystic artery was studied in 240 laparoscopic procedures. Origin of cysticartery from right hepatic artery was observed in 82% cases. Double cystic arteries were observed in 8%cases. Common hepatic artery gave rise to 6% cystic arteries. Cystic arteries originated fromgastroduodenal artery in 3% cases. Hepatic parenchyma gave rise to 2% cases.CONCLUSION: Percentage of variations in cystic artery as compared to Caucasians are not different inour study.These variations should be kept in mind to reduce complications.KEYWORDS: laparoscopic cholecystectomy, calot’s triangle, hepatic artery, cystic artery.

scholarly journals Triangle of Safety Technique: A New Approach to Laparoscopic Cholecystectomy

HPB Surgery ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Abdulrahman F. M. S. Almutairi ◽  
Yousef A. M. S. Hussain
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Operating Time ◽  
Gallbladder Wall ◽  
Cystic Artery ◽  
Safe Procedure ◽  
Calot’S Triangle ◽  
Safety Technique ◽  
Delayed Complications ◽  
Cbd Injury

Backgrounds and Study Aims. Common bile duct (CBD) injury is one of the most serious complications of laparoscopic cholecystectomy (LC). Misidentification of the CBD during dissection of the Calot's triangle can lead to such injuries. The aim of the authors in this study is to present a new safe triangle of dissection. Patients and Method. 501 patients under went LC in the following approach; The cystic artery is identified and mobilized from the gall bladder (GB) medial wall down towards the cystic duct which would simultaneously divide the medial GB peritoneal attachment. This is then followed by dividing the lateral peritoneal attachment. The GB will be unfolded and the borders of the triangle of safety (TST) are achieved: cystic artery medially, cystic duct laterally and the gallbladder wall superiorly. The floor of the triangle is then divided to delineate both cystic duct and artery in an area relatively far from CBD. Results. There were little significant immediate or delayed complications. The mean operating time was 68 minutes, nearly equivalent to the conventional method. Conclusions. Dissection at TST appears to be a safe procedure which clearly demonstrates the cystic duct and may help to reduce the CBD injuries.

scholarly journals ANATOMICAL VARIATIONS OF EXTRA HEPATIC BILIARY SYSTEM IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY IN CMH & PEMH RAWALPINDI

2021 ◽  
Vol 71 (3) ◽  
pp. 916-19
Author(s):  
Muhammad Ali Muazzam ◽  
Syed Mukarram Hussain ◽  
Muhammad Tanvir Ahmed Qureshi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Gall Bladder ◽  
Hepatic Artery ◽  
Biliary Tract ◽  
Cystic Duct ◽  
Anatomical Variations ◽  
Cystic Artery ◽  
Military Hospital

Objective: To assess the frequency of anatomical variations of the extra-hepatic biliary tract in patients undergoing laparoscopic cholecystectomy in Combined Military Hospital & Pak Emirates Military Hospital Rawalpindi. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital & Pak Emirates Military Hospital, Rawalpindi, from Mar to Aug 2017. Methodology: A total of 136 patients of either gender with cholelithiasis of more than one month were included. Participants were distributed into equal number of groups for both hospitals by lottery method. All the participants had under gone laparoscopic cholecystectomy by consultant general surgeon or senior registrar under direct supervision. Structures mainly assessed for variations were gall bladder, cystic duct, common hepatic duct, supraduodenal part of common bile duct, cystic artery, and hepatic artery which were characteristically encountered during laparoscopy. Results: Overall Extra hepatic biliary variations were 136 (23%), at Combined Military Hospital 68 (16%) and Pak Emirates Military Hospital 68 (29.4%). Gall bladder anomaly was seen in 3% patients, cystic duct anomaly 4.4%, supraduodenal part of common bile duct anomaly 0.7%, cystic artery anomaly 11% and hepatic artery anomaly was seen in 3.6% patients (p>0.05). Conclusion:  Anatomic variations were found to be not uncommon in our set up. Thus, there is a need for doctors to continuously refresh knowledge of normal anatomy and the variants of biliary tract.

Variations of Cystic Duct and Its Clinical Significance

2021 ◽  
Vol 9 (4) ◽  
pp. 8120-8126
Author(s):  
K. Sangameswaran ◽  
Keyword(s):  
Bile Duct ◽  
Cystic Duct ◽  
Gallstone Disease ◽  
Cystic Artery ◽  
Normal Anatomy ◽  
Biliary Anatomy ◽  
Medical College ◽  
Gallbladder Surgery ◽  
The Common ◽  
Common Problems

Background: Cystic duct drains the bile from the gallbladder into the common bile duct. Gallstone disease is one of the most common problems affecting the digestive tract and may lead to many complications. To avoid the complications in these patients the gallbladder is removed surgically (Cholecystectomy). Ligation of cystic duct and cystic artery is a prerequisite procedure when cholecystectomy is done. Understanding about the normal anatomy & the possible variations in biliary ductal system is important for the surgeons for doing cholecystectomy surgery successfully. Errors during gallbladder surgery commonly result from failure to appreciate the common variations in the anatomy of the biliary system. Aim of the study: To find out the incidence of variations in the length, course, and termination of cystic duct in cadavers. Materials and Methods: Present study was done in 50 adult cadavers in the Department of Anatomy, Government Tiruvannamalai medical college, Tamilnadu. Meticulous dissection was done in the hepatobiliary system of these cadavers. Observations: During the study variations in the length of cystic duct, course and different modes of insertion of cystic duct were observed. Conclusion: Knowledge of variations in the length of cystic duct and knowing about different modes of course & insertion of cystic duct is necessary for surgeons while conducting cholecystectomy. The risk of iatrogenic injury is especially high in cases where the biliary anatomy is misidentified prior to surgery. KEY WORDS: Cystic duct, Gallbladder, Cholecystectomy.

scholarly journals Experience of using polymer clips in patients with acute calculous cholecystitis in combination with chronic viral hepatitis

2018 ◽  
Vol 22 (3) ◽  
pp. 485-488
Author(s):  
M.A. Kashtalian ◽  
A.O. Kolotvіn ◽  
L.I. Kolotvina ◽  
A.A. Kvasnevskiy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Viral Hepatitis ◽  
Cystic Duct ◽  
Chronic Viral Hepatitis ◽  
Study Group ◽  
Acute Calculous Cholecystitis ◽  
Domestic Literature ◽  
Lock In ◽  
Calculous Cholecystitis

In the article, the authors summarize the materials presented in the scientific foreign and domestic literature and acquired their own experience in the use of polymer and metal clips in patients with acute calculous cholecystitis (GKH) in combination with chronic viral hepatitis (CWG). The aim of the work was to optimize the clipping of the cystic duct during laparoscopic cholecystectomy in patients with acute calculous cholecystitis and chronic viral hepatitis. In the period from 2015 to 2017, 822 patients with GCS performed laparoscopic cholecystectomy (LHE). Clinching of the bladder duct and the bladder artery was carried out with metal clips in 339 (41.2%) patients and polymer clips in the type “Hem-o-lock” in 483 (58.8%) patients. In the study group, 59 (7.1%) patients with CKD in combination with CKD were included, in which for clumping of the bladder duct and bladder artery in 17 (28.8%) cases metal clips were used and in 42 (71.2%) cases polymeric. “Slipping” of clips from the clipper among the patients, in whom clapping was done with metal clips, was in 58 (17.1%) patients without CKD, and in 5 (29.4%) patients with CKD with CWG. When clumping with polymer clips, “slipping” clips from the applier was in 17 (3.5%) patients without HV and in 1 (2.4%) patients with HVC. Thus, polymer clips of the Hem-o-lock type are designed for use with an appropriate clipper, which fully repeats the structure of the clip, the problem of “slipping” in patients with GCS during the clumping of the bladder duct and bladder arteries can minimize and prevent the occurrence of complications such as bile duct and bleeding.

scholarly journals Clipless laparoscopic cholecystectomy: 3 Port access.

2020 ◽  
Vol 27 (06) ◽  
pp. 1124-1127
Author(s):  
Ghulam Hassan ◽  
Saad Gulzar ◽  
Tariq Iqbal ◽  
Mohammad Imranul Haque
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Harmonic Scalpel ◽  
Cystic Artery ◽  
Safe Alternative ◽  
Medical College ◽  
Post Operative Pain ◽  
Port Access ◽  
Electric Injury ◽  
Single Instrument

Objectives: Use to ultrasound vibrations instead of electric current makes Harmonic Scalpel a safer and more efficient instrument for dissection during laparoscopic surgeries. The property of both coagulation and cutting using single Harmonic Scalpel instruments saves time of surgery reducing anesthesia load. Cystic artery and liver bed dissection has been widely used and established but a contemporary approach is the coagulation and cutting of cystic duct with Harmonic Scalpel eliminating the need for clips and reducing the epigastric port size from 10mm to 5mm thus reducing post-operative pain. Study Design: Prospective Study. Setting: This study was conducted in Department of surgery Quaid e Azam Medical College Bahawalpur. Period: Dec, 2015 to Dec, 2017. Material & Methods: 60 patients undergoing laparoscopic cholecystectomy 3 ports were introduced one 10mm and two 5mm. the dissection and division of both cystic artery and duct was done by a single instrument, Harmonic Scalpel after tying the cystic duct with 2/0 extracorporeal knot. Results: None of the patients developed Major or Minor bile leaks or hemorrhage. Conclusion: Harmonic scalpel provides a safe alternative for dissecting and division of cystic duct and may replace the more widely used clip technique. The number of ports can be reduced to 3 and size reduced from 10mm to 5 mm. Harmonic scalpel technique eliminates the time wasted during changing of instruments per-operatively and also reduces the risk of remote electric injury.

scholarly journals Dilatation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and stone extraction for Patients with Secondary Choledocholithiasis

2019 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration ◽  
Stone Extraction ◽  
Non Invasive ◽  
Transcystic Approach ◽  
Surgical Modality ◽  
Cbd Exploration

Abstract The advent of endoscopic and laporoscopic techniques changed surgery in many regards. A number of options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct (CBD) exploration with the choledocotomy followed by laparoscopic cholecystectomy (LC) has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the CBD. For this purpose, we modified the surgical modality by laparoscopic transcystic approach with dilatation of the cystic duct confluence in CBD exploration (LTD-CBDE). The aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE based on our preliminary experience.

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