A Study of Anatomical Variability in the Position of the Cystic Artery During Laparoscopic Visualization at Kempegowda Institute of Medical Sciences (KIMS) Hospital, Bengaluru.

BACKGROUND

Laparoscopic cholecystectomy is the gold standard for gallbladder removal, requiring precise knowledge of Calot's triangle to prevent complications. Variations in the cystic artery's length, course, and position pose challenges in achieving a critical view of safety. Misidentification can lead to bile duct injury or bleeding, often necessitating conversion to open surgery. Careful dissection guided by anatomical understanding is essential for safer procedures.

AIM

This study aims to identify the prevalence of anatomical variations in the position of the cystic artery in relation to the cystic duct in Calot's triangle among patients undergoing laparoscopic cholecystectomy at a tertiary care hospital.

METHODS

A prospective observational study was conducted to identify intraoperative variations in the position of the cystic artery in relation to the cystic duct in patients undergoing laparoscopic cholecystectomy over 19 months. A total of 100 patients aged above 18 years, posted for cholecystectomy, were included. Patients with a history of previous abdominal surgeries and those cases converted to open surgeries were excluded. Positions of the cystic artery were categorized into posteromedial, posterolateral, anterior, and others.  Results: Out of 100 cases of laparoscopic cholecystectomy, 71 patients were females and 29 were males, showing a female predominance. Moreover, 87 patients had a cystic artery posteromedial to the cystic duct, seven had a cystic artery at posterolateral position to the cystic duct, five patients had anterior to the cystic duct, and in one patient, it was absent. In one patient, it couldn't be made out due to necrosis. There was no incidence of any postoperative bile leak in any patients.  Conclusions: The most common position of the cystic artery in Calot's triangle was posteromedial (87%) to the cystic duct. A thorough knowledge of the anatomy and variations of the extrahepatic biliary tract and arterial supply is essential for reducing bleeding, preserving visibility, and avoiding damage to other biliary and vascular structures. This understanding can guide us toward safer dissection of Calot's triangle and conducting a successful laparoscopic cholecystectomy.