Laparoscopic visualization of the cystic artery anatomy

Uncontrolled bleeding from the cystic artery and its branches is a serious problem that may increase the risk of intraoperative lesions to vital vascu lar and biliary structures. On laparoscopic visualization anatomic relation s are seen differently than during conventional surgery, so proper knowledg e of the hepatobiliary triangle anatomic structures under the conditions of laparoscopic visualization is required. We present an original classificat ion of the anatomic variations of the cystic artery into two main groups ba sed on our experience with 200 Laparoscopic cholecystectomies, with due con sideration of the known anatomicotopographic relations. Group I designates a cystic artery situated within the hepatobiliary triangle on laparoscopic visualization. This group included three types: (1) normally lying cystic a rtery, found in 147 (73.5%) patients; (2) most common cystic artery variati on, manifesting as its doubling, present in 31 (15.5%) patients; and (3) th e cystic artery originating from the aberrant right hepatic artery, observe d in 11 (5.5%) patients. Group II designates a cystic artery that could not be found within the hepatobiliary triangle on laparoscopic dissection. Thi s group included two types of variation: (1) cystic artery originating from the gastroduodenal artery, found in nine (4.5%) patients; and (2) cystic a rtery originating from the Left hepatic artery, recorded in two (1%) patien ts.