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Surgery
Published in Seema Khan, Get Through, 2020
Calot’s triangle consists of the lower edge of the liver superiorly, the common hepatic duct medially and the cystic duct inferiorly. It contains the cystic artery and Calot’s lymph node. During laparoscopic cholecystectomy, it is important to dissect out Calot’s triangle so as to visualize the structures and avoid biliary damage.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
There are many variations in biliary tree anatomy and therefore it is important to correctly identify the structures forming Calot’s triangle before starting dissection in a cholecystectomy. The gallbladder is supplied by the cystic artery, a branch of the right hepatic artery, which requires ligation during the surgery. The cystic artery lies in Calot’s triangle, which is bordered by the inferior border of the liver, the cystic duct, and the common hepatic duct.
The Gallbladder and Bile Ducts
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Calot’s triangle, or the hepatobiliary triangle, was initially described by Calot as the space bordered by the cystic duct inferiorly, the common hepatic duct medially and the superior border of the cystic artery. This has been modified in contemporary literature to be the area bound superiorly by the inferior surface of the liver, laterally by the cystic duct and the medial border of the gallbladder and medially by the common hepatic duct. It is an important surgical landmark as the cystic artery usually can be found within its boundaries and should be identified by surgeons performing a cholecystectomy to avoid damage to the extrahepatic biliary system (Figure67.2a).
A Systematic Review of Laparoscopic Cholecystectomy in Situs Inversus
Published in Journal of Investigative Surgery, 2021
Mohamed Ali Chaouch, Hichem Jerraya, Mohamed Wejih Dougaz, Ramzi Nouira, Chadli Dziri
Many people with SI may be unaware of their condition until they seek medical attention [18]. Therefore, clinical diagnosis of cholelithiasis could be difficult. Ultrasonography, abdominal CT scan, and abdominal MRI could confirm, determine the type of visceral transposition, allow a plan of the surgical procedure and decrease intra-operative unexpected events and post-operative complications [103]. Intra-operative findings confirm these radiological implications [3, 11, 12, 15, 23, 34]. As for the surgical procedure, four ports, three ports, or a single port were reported but they were limited. One of the major problems in case of SI is the surgeon’s dominant hand. The surgeon must expose the Calot triangle clearly. The gallbladder fundus should be grasped upward to the left and gallbladder neck grasped down to the left. This traction allows misalignment of the cystic duct from the CBD and permits a critical view of safety [103, 104]. The Calot triangle dissection should be performed lateral to the cystic artery lymph node with visualization of the cystic duct or CBD insertion.
Occlusion of the cystic duct with cyanoacrylate glue at laparoscopic subtotal fenestrating cholecystectomy for a difficult gallbladder
Published in Acta Chirurgica Belgica, 2022
Deborah C. Jenner, Michail Klimovskij, Michael Nicholls, Tom Bates
Closure of the cystic duct in a hostile Calot’s triangle remains an occasional problem. In a systematic review and meta-analysis of subtotal cholecystectomy for difficult gallbladders [2] the cystic duct or gallbladder stump was left open in 100 of 1161 patients (8.6%). This led to postoperative bile leaks in 42% versus 16.5% in those patients where the duct was closed, subhepatic collections in 19% versus 1.5% and reoperation rates of 5% versus 1.5%. Although these differences were not statistically significant on weighted analysis there were similar trends for retained stones, the need for post-operative ERCP and 30-day mortality. Bile duct leaks were noted to resolve spontaneously in 69 patients after 4to12 days, but this only accounted for a third of such cases.
Anatomic Variation of the Cystic Artery: New Findings and Potential Implications
Published in Journal of Investigative Surgery, 2021
Li Li, Qiang Li, Mingguo Xie, Wenwei Zuo, Bin Song
Specifically, the cystic artery was identified if a nodular and curvilinear enhanced structure around the gallbladder joining the right hepatic artery or other parent artery was identified [25]; the origination (parent artery) was the artery to which the previously described structure was connected [25]; the cystic artery termination was deemed to be the nodular enhanced structure seen as the cystic artery joined the gallbladder. When a cystic artery has no bifurcation, the terminus was identified as the point at which the cystic artery was no longer visible. When a cystic artery bifurcated into two or more branches, the terminus was identified as the point of bifurcation of the cystic artery. We assess the terminus for each cystic artery, not per-patient, as some patients had multiple cystic arteries. The Calot triangle consists of the common hepatic duct, cystic duct, and undersurface of the liver. The distance between the origin of the cystic artery and the gallbladder was determined as the nearest distance between the origin of the cystic artery and the surface of gallbladder, and if a cystic artery originating immediately adjacent to the surface of the gallbladder, a zero-distance was assigned. The angle between the cystic artery and its parent artery was also measured, and if the cystic artery and the parent artery course in a straight line, an angle of 0° was assigned. In enhanced dual source CT, the common bile duct was identified when a tubular low-attenuation structures (attenuation slightly higher than that of the surrounding fat) was seen; the cystic duct had a similar attenuation and confluence to the common bile duct [25].