Do you cut the cystic artery in cholecystectomy?
The cystic artery is the key structure sought to be clipped or ligated during laparoscopic or conventional cholecystectomy.
What are the 5 anatomic landmarks when you do laparoscopic cholecystectomy?
These fixed anatomical landmarks include bile duct and base of segment 4 (B), Rouviere’s sulcus and segment 4 (S), hepatic artery (A), umbilical fissure (F), and enteric viscera (E), e.g., duodenum, pylorus[44].
Which duct is tied in laparoscopic cholecystectomy?
The cystic duct joins the gallbladder to the bile duct and is one of the important structures needing proper identification and division during a standard cholecystectomy.
How can surgeon identify cystic artery during laparoscopic cholecystectomy?
Proper recognition, ligation, and cut of the cystic duct and cystic artery with branches (dorsal and ventral) remain an integral condition for the removal of the gallbladder. Calot’s triangle, as an orientation structure, determines the most common location of the cystic artery.
Where is cystic artery?
Classical single cystic artery: The cystic artery originates from the right hepatic artery within Calot’s triangle. When approaching the gallbladder, the artery is divided into deep and superficial branches at the neck of the gallbladder. The superficial branch proceeds along the left side of the gallbladder.
What is cystic plate?
The cystic plate is a condensation of fibro-areolar tissue that separates the gallbladder from the liver parenchyma. The cystic plate is well formed in the gallbladder body but gets thinner towards the gallbladder fundus.
What is cystic artery?
The cystic artery is a branch of the right hepatic artery and is usually given off in Calot’s triangle. It has a variable length and becomes adherent to the gallbladder in the neck or body area. The course and length of the cystic artery in Calot’s triangle are variable.
What is used to ligate the cystic duct?
The technique of Roeder slip-loop knotting was used to ligate the cystic artery and duct in a consecutive series of 80 patients undergoing laparoscopic cholecystectomy. This clinical experience has confirmed its safety and ease of execution.
Where are the incisions made for a laparoscopic cholecystectomy?
A laparoscopic cholecystectomy is surgery to remove your gallbladder. The surgeon makes a few small incisions on the right side of your abdomen (belly). The surgeon uses one incision to insert a laparoscope, a thin tube with a camera on the end. This shows your gallbladder on a screen.
Where is the cystic duct?
The cystic duct connects the top of the gallbladder’s neck to the common hepatic duct. It then joins the common bile duct, which meets pancreatic duct before it empties into the duodenum. In the average adult, the cystic duct measures four centimeters in length.
What does the cystic artery branch off of?
What is the purpose of cystic artery variations?
Purpose: While laparoscopic cholecystectomy can be a routine procedure when biliary anatomy is normally located, cystic artery variations can easily disorientate the inexperienced surgeon to the anatomy of the hepatobiliary triangle. This study presents the clinically important anatomical variations of the cystic artery.
Is it necessary to ligate two arteries to the gallbladder?
Therefore it may be occasionally necessary to ligate two arteries to the gallbladder. When the cystic artery is given off not from the RHA but from other vessels like the common hepatic artery or the left hepatic artery (2–5%) it crosses the bile duct anteriorly and may be prone to injury.
How is the gall bladder and cystic artery cauterized?
The gall bladder is removed with its duct ( cystic duct) close to its junction with the common bile duct, both cystic duct and cystic artery ligated by clips ( less commonly by suture material), cystic artery cauterization carries risk of uncontrolled bleeding…
Can a cystic artery be cauterized safely?
Conclusion: cystic artery can be cauterized safely provided appropriate power setting of the monopolar diathermy done and cystic duct is not abnormally wide.