(5) reported a "two-step" strategy consisting of embolization of the cystic artery
followed by elective cholecystectomy.
The conversion of laparoscopic cholecystectomy is extremely important when there is difficult anatomy around Calot's triangle, as there is more chance of bile duct and cystic artery
injury in this situation.
Intra-operative complications included gall bladder perforation in 15.62% and bleeding from cystic artery
in 3.12% patients.
and ductus were found, and cut through with putting hemoclips.
The scoring system included five aspects; appearance and adhesion of Gall Bladder (GB), distension or contracture degree of GB, ease in access, local or septic complications, and time required for cystic artery
and duct identification.
Sharp dissection with hook electrocautery was used to separate the gallbladder from liver bed, and blunt dissection with dissector was used to skeletonize the cystic artery
and bile duct within Calot's triangle.
As mentioned earlier, intrabiliary clots which form due to hemobilia are often mistaken as gallstones; however, even when gallstones are indeed present, there can still be concurrent hemobilia, especially in cases in which the stone erodes through the cystic artery
or other vascular structures and cause bleeding, analogous to how a stone can erode and fistulize into the duodenum and cause outlet obstruction in Bouveret's syndrome .
The cystic artery
was situated behind the cystic duct, outside the Calot triangle, and had only a posterior branch that entered and vascularized the posterior wall of the gallbladder (Figure 4).
Similarly in LC also, subtotal laparoscopic cholecystectomy (SLC) may be performed for difficult cases.3 During SLC, a portion of gall bladder (GB) is left by saving cystic artery
and cystic duct and dissection of remaining GB from liver bed is done.
Performing a gentle dissection of fatty-areolar tissues of the Calot triangle, two structures running parallels into the gallbladder are exposed: cystic duct and cystic artery
. Once cystic duct and artery are identified, a single 5 mm titanium clip is placed on the junction between the infundibulum and the cystic duct.
Dissection of the critical structures revealed the cystic artery
to be anterior to the cystic duct with origination from either the proper or right hepatic artery.
The cystic artery
was identified, ligated, and divided.