Laparoscopic surgery has become a common procedure performed by surgeons and gynecologists in many parts of the world.
Laparoscopic cholecystectomy has rapidly been adopted by surgeons. It has become "the gold standard" therapy for management of symptomatic cholelithiasis, but concerns remain about its safety due to bile duct injury and intraoperative bleeding.
Among
them, uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage.
We reviewed the anatomy of the cystic artery and its variations as seen through the video laparoscope, according to our classification (Group I, II, III & IV) A group I (normal cystic artery) was found in 86%, group II (doubling of the cystic
artery)
was found in 10%, group III (a low-lying cystic artery) in 3% and group IV (a tortuous right hepatic artery)was found in 1% of patients.
The anatomy of the cystic artery is highly variable and knowledge of the variations as well as careful dissection of Calot's triangle are improtant in avoiding complications. The basic surgical principles of awareness of variant anatomy and
identification of all structures prior to division (30°forward oblique telescope gives better visualization of the ventral and dorsal aspects of the structure and helps maintain to coaxial alignment to the operative field) are essential for safe
laparoscopic cholecystectomy.
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