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Cholecystectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The cystic artery usually traverses Calot's triangle arising from an anterior right hepatic artery. It can be ligated and divided safely only if it can be shown to be supplying the gallbladder (and nothing else). There are many variations of arterial anatomy which can confuse and render the right hepatic artery at risk. One such is the caterpillar hump (of Moynihan) configuration, making it unduly prominent in Calot's triangle (Figure 54.5). Dissection of the cystic duct down to the junction with CBD is relatively straightforward being in continuity with Hartmann's pouch. Nonetheless, variations include a low insertion near the duodenum or even within the pancreas. Where there is doubt, a cholangiogram is indicated. Both cystic duct and artery can be divided and ligated with absorbable material.
General Surgery
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
A cholecystectomy is a common procedure for patients to undertake so it is important to know about for finals. They can be performed either via an open procedure (using a Kocher incision) or laparoscopically (Figure 12.1.1). During the procedure, the operating surgeon will first identify the cystic artery, which sits within Calot's triangle (formed by the lower liver border, the cystic duct and the common hepatic duct). The cystic artery is ligated, and the gallbladder is then dissected.
Abdominal surgery
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
The laparoscopic removal of a gallbladder involves the same basic principles as removing it with an open surgical procedure. A laparoscopic procedure involves injecting gas into the abdominal cavity. This creates a space between the lining of the abdomen and the guts allowing visualization of the gallbladder and its surrounding structures. After identifying the gallbladder dissection of the cystic duct and cystic artery takes place. Once these have been positively identified the cystic duct and cystic artery are ligated. Many surgeons apply clips to these structures, dividing between the first and second clip leaving two clips on the cystic artery and two clips on the cystic duct within the abdominal cavity. This reduces the risk of the clips dislodging and either bile leaking into the abdominal cavity or bleeding. Once the cystic duct and cystic artery are ligated the gallbladder can be detached from the liver bed by blunt dissection, often using diathermy.
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
The primary findings of this study are: (1) cystic artery terminations are predominately found in ventral Calot triangle plane (50.8%, type II); (2) cystic artery origin immediately adjacent to the gallbladder surface was seen in 11/256 (4.3%); and (3) zero angle between the cystic artery and its parent artery was observed in 17 of 256 cystic arteries (6.6%). These results have not been reported in previous literature. In our study, no case involved vascular and biliary injury occurred. It is conceivable that knowledge of preoperative such variations may decrease the potential risk of accidental vascular and biliary injure.
Cholecystectomy during esophagectomy is safe but unnecessary
Published in Acta Chirurgica Belgica, 2020
Francesco Cavallin, Marco Scarpa, Matteo Cagol, Rita Alfieri, Alberto Ruol, Vanna Chiarion Sileni, Massimo Rugge, Ermanno Ancona, Carlo Castoro
Cholecystectomy was performed at the end of the laparotomic/laparoscopic part of the esophagectomy in patients with gallstones or previous symptoms (i.e. right upper abdomen postprandial pain, heavy feeling on the right side, epigastric discomfort). Cholecystectomy was performed as usual ligating and sectioning the cystic artery and the cystic duct. Then the gallbladder was dissected away from the liver bed. A drain was left in place under the liver for few days.