scholarly journals Triangle of Safety Technique: A New Approach to Laparoscopic Cholecystectomy

HPB Surgery ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Abdulrahman F. M. S. Almutairi ◽  
Yousef A. M. S. Hussain
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Operating Time ◽  
Gallbladder Wall ◽  
Cystic Artery ◽  
Safe Procedure ◽  
Calot’S Triangle ◽  
Safety Technique ◽  
Delayed Complications ◽  
Cbd Injury

Backgrounds and Study Aims. Common bile duct (CBD) injury is one of the most serious complications of laparoscopic cholecystectomy (LC). Misidentification of the CBD during dissection of the Calot's triangle can lead to such injuries. The aim of the authors in this study is to present a new safe triangle of dissection. Patients and Method. 501 patients under went LC in the following approach; The cystic artery is identified and mobilized from the gall bladder (GB) medial wall down towards the cystic duct which would simultaneously divide the medial GB peritoneal attachment. This is then followed by dividing the lateral peritoneal attachment. The GB will be unfolded and the borders of the triangle of safety (TST) are achieved: cystic artery medially, cystic duct laterally and the gallbladder wall superiorly. The floor of the triangle is then divided to delineate both cystic duct and artery in an area relatively far from CBD. Results. There were little significant immediate or delayed complications. The mean operating time was 68 minutes, nearly equivalent to the conventional method. Conclusions. Dissection at TST appears to be a safe procedure which clearly demonstrates the cystic duct and may help to reduce the CBD injuries.

scholarly journals CYSTIC ARTERY VARIATIONS IN LAPAROSCOPIC CHOLECYSTECTOMY

1969 ◽  
Vol 6 (1) ◽  
pp. 714-717
Author(s):  
MUHAMMAD HUSSAIN ◽  
ADNAN BADAR ◽  
MANZOOR ALI ◽  
SHAHID ALAM ◽  
NAIK ZADA ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Hepatic Artery ◽  
Cystic Duct ◽  
Gold Standard ◽  
Cystic Artery ◽  
Common Hepatic Artery ◽  
Hepatic Parenchyma ◽  
Right Hepatic Artery ◽  
Calot’S Triangle

BACKGROUND: Lap cholecystectomy is gold standard for cholelithiasis. Earlier the incidence ofmorbidity and mortality was higher. Later on with the understanding of anatomy and fine techniquesboth morbidity and mortality decreased. Understanding of the anatomy of calot’s triangle reduces thecomplications of the procedure.OBJECTIVE: To study the pattern of variations in cystic artery and comparison with Caucasians.MATERIAL AND METHODS: All laparoscopic cholecystectomies performed in Shah MedicalCentre,over a period of 1 year from January 2013 to December 2013,in whom detailed anatomy ofcalot’s triangle was clearly displayed were included in the study. Those laparoscopic cholecystectomiesin whom the detailed anatomy was not clear were excluded from the study.Laparoscopic cholecystectomies were performed under general anesthesia. The anatomy of cystic arteryand its branches were identified, and it was also correlated in relation to cystic duct and common hepaticduct.We performed 240 lap cholecystectomies over a period of 1 year from January 2013 to December 2013.RESULTS: The pattern of cystic artery was studied in 240 laparoscopic procedures. Origin of cysticartery from right hepatic artery was observed in 82% cases. Double cystic arteries were observed in 8%cases. Common hepatic artery gave rise to 6% cystic arteries. Cystic arteries originated fromgastroduodenal artery in 3% cases. Hepatic parenchyma gave rise to 2% cases.CONCLUSION: Percentage of variations in cystic artery as compared to Caucasians are not different inour study.These variations should be kept in mind to reduce complications.KEYWORDS: laparoscopic cholecystectomy, calot’s triangle, hepatic artery, cystic artery.

scholarly journals Artery to Cystic Duct: A Consistent Branch of Cystic Artery Seen in Laparoscopic Cholecystectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Arshad Rashid ◽  
Majid Mushtaque ◽  
Rajandeep Singh Bali ◽  
Saima Nazir ◽  
Suhail Khuroo ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Cystic Duct ◽  
Cystic Artery ◽  
Branching Pattern ◽  
Accurate Identification ◽  
Calot’S Triangle ◽  
Arterial Bleeding ◽  
Bile Duct Damage

Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47%) patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot’s triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries.

scholarly journals LAPAROSCOPIC CHOLECYSTECTOMY

2010 ◽  
Vol 17 (03) ◽  
pp. 373-378
Author(s):  
JAHANGIR SARWAR KHAN ◽  
MOHAMMAD IQBAL ◽  
HAMID HASAN
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Demographic Data ◽  
Operating Time ◽  
Abdominal Ultrasound ◽  
Safe Procedure ◽  
Accident And Emergency ◽  
Set Up ◽  
Cbd Injury ◽  
Surgical Unit

Objective: To determine the frequency of common bile duct (CBD) injury in laparoscopic cholecystectomy in our settings, in my last 500 cases, after going through the learning curve associated CBD injuries. Design: Descriptive study. Place and Duration of Study: Surgical Unit-I, Rawalpindi General Hospital and the author’s Surgical Clinics from January 2003 to December 2008. Patients and Methods: Five hundred patients undergoing laparoscopic cholecystectomy by the same surgeon were included. The important variables included demographic data, intra operative time and findings, frequency of CBD injury and post operative hospital stay. Results: There were 419(83.8%) females and 81(16.2%) males with mean age 45.04±11.03 years. 294(58.8% )patients had chronic cholecystitis with Cholelithiasis and were admitted through Out Patient Department whereas 206(41.2%) were admitted through Accident and Emergency Department with acutecholecystitis. Abdominal ultrasound showed multiple calculi in 351(70.2%) patients and 149(29.8%) patients had single calculus preoperatively. Empyema was found in 97(19.4%) cases whereas adhesions were present in 182( 36.4%) patients. In our study frequency of CBD injury was 1%. Mean operating time was 35 minutes. 96.8 % of the patients were discharged within 48 hrs of operation. Conclusion: LaparoscopicCholecystectomy in our set up proved to be a safe procedure, having frequency of CBD injury of only 1% and a short hospital stay 493(96.8% )being discharged in less than 2 days.

scholarly journals Is suture ligation of cystic duct in laparoscopic cholecystectomy a safe alternative to clipping? Our experience in a rural centre

2019 ◽  
Vol 6 (10) ◽  
pp. 3715
Author(s):  
K. R. Manoj Prabu ◽  
Dhinesh Balaji ◽  
Vishwanath M. Pai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Cystic Duct ◽  
Operating Time ◽  
Cost Effective ◽  
Safe Alternative ◽  
Suture Ligation ◽  
Medical College ◽  
The Mean ◽  
Mean Time

Background: Laparoscopic cholecystectomy is one of the most common surgeries performed nowadays. It remains an enigma regarding efficacy, safety and postoperative complications for using suture ligation for ligating cystic duct in laparoscopic cholecystectomy. The aim of the present study was to study the efficacy of ligating the cystic duct with sutures in laparoscopic cholecystectomy.Methods: This prospective study was performed between June 2018 and April 2019 in Saveetha Medical College and Hospital, in a rural center, Kanchipuram, India. All the patients included consented for the study. Patients who underwent subtotal cholecystectomy were excluded from the study.Results: The study included 70 patients who underwent laparoscopic cholecystectomy in a single unit. All cases were operated by a single surgeon. Of the 70 patients, the Cystic duct (CD) was simply ligated in 55 patients with CD <5 mm in diameter. The CD in 15 of those patients had to be divided and sutured in continuity for wide CD (>5 mm). The mean time for ligation of cystic duct was 5 min. Similarly, the mean time for ligation of cystic artery was 1.50 min. The mean operative time was 50 mins. There were no postoperative complications, such as bile leakage.Conclusions: SL of the CD is a very safe and secure alternative to the application of metal clips. It can be used in dilated CD, readily available and very cost effective and the complications of clips are avoided. The only disadvantage is that it needs expertise to perform and subsequently increasing the operating time. This technique is recommended in all laparoscopic cholecystectomies, especially in difficult cases.

scholarly journals Clipless laparoscopic cholecystectomy: 3 Port access.

2020 ◽  
Vol 27 (06) ◽  
pp. 1124-1127
Author(s):  
Ghulam Hassan ◽  
Saad Gulzar ◽  
Tariq Iqbal ◽  
Mohammad Imranul Haque
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Harmonic Scalpel ◽  
Cystic Artery ◽  
Safe Alternative ◽  
Medical College ◽  
Post Operative Pain ◽  
Port Access ◽  
Electric Injury ◽  
Single Instrument

Objectives: Use to ultrasound vibrations instead of electric current makes Harmonic Scalpel a safer and more efficient instrument for dissection during laparoscopic surgeries. The property of both coagulation and cutting using single Harmonic Scalpel instruments saves time of surgery reducing anesthesia load. Cystic artery and liver bed dissection has been widely used and established but a contemporary approach is the coagulation and cutting of cystic duct with Harmonic Scalpel eliminating the need for clips and reducing the epigastric port size from 10mm to 5mm thus reducing post-operative pain. Study Design: Prospective Study. Setting: This study was conducted in Department of surgery Quaid e Azam Medical College Bahawalpur. Period: Dec, 2015 to Dec, 2017. Material & Methods: 60 patients undergoing laparoscopic cholecystectomy 3 ports were introduced one 10mm and two 5mm. the dissection and division of both cystic artery and duct was done by a single instrument, Harmonic Scalpel after tying the cystic duct with 2/0 extracorporeal knot. Results: None of the patients developed Major or Minor bile leaks or hemorrhage. Conclusion: Harmonic scalpel provides a safe alternative for dissecting and division of cystic duct and may replace the more widely used clip technique. The number of ports can be reduced to 3 and size reduced from 10mm to 5 mm. Harmonic scalpel technique eliminates the time wasted during changing of instruments per-operatively and also reduces the risk of remote electric injury.

scholarly journals Cystic vein: a guide for safer laparoscopic cholecystectomy

2017 ◽  
Vol 4 (10) ◽  
pp. 3238
Author(s):  
Debasish Samal ◽  
Rashmiranjan Sahoo ◽  
Sujata Priyadarsini Mishra ◽  
Krishnendu B. Maiti ◽  
Kalpita Patra ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Injury ◽  
Cystic Duct ◽  
Cystic Artery ◽  
Anatomic Landmark ◽  
Complications Of Laparoscopic Cholecystectomy ◽  
Constant Feature ◽  
The Relationship

Background: Major complications of laparoscopic cholecystectomy are bleeding and bile duct injury, and it is necessary to clearly identify structures endoscopically to keep bleeding and injury from occurring. The aim of this study was to depict the anatomic landmark in the Calots triangle, a vein (cystic vein), a constant feature which can help Laparoscopic surgeons to conduct a safe LC along with other precautions to be adopted. Methods: A total of 100 patients (58 male, 42 female) who underwent cholecystectomy were examined preoperatively by clinically. The origin and number of cystic veins and their relationship with the Calot triangle was evaluated. Results: The cystic veins were delineated intraoperatively in 80 of the 93 patients. The relationship between the cystic vein and the Calot triangle was identified in 80 (86.02%) of the 93 patients. One cystic vein was found in 53 (66.25%) patients, while multiple cystic veins were found in 27 (33.75%) patients. All these veins are above the cystic common bile duct junction. Conclusion: The configuration of the cystic veins and their relationship in the Calot triangle with cystic artery and cystic duct can be identified intraoperatively and used as a guideline for safe laparoscopic cholecystectomy. 

scholarly journals Interval Laparoscopic Cholecystectomy in the Management of Acute Biliary Pancreatitis

HPB Surgery ◽  
2000 ◽  
Vol 11 (5) ◽  
pp. 319-323 ◽  
Author(s):  
M. D. Pinhas Schachter ◽  
M. D. Timor Peleg ◽  
M. D. Oded Cohen
Keyword(s):  
Acute Pancreatitis ◽  
Laparoscopic Cholecystectomy ◽  
Traditional Approach ◽  
Open Cholecystectomy ◽  
Gallbladder Disease ◽  
Operating Time ◽  
Biliary Pancreatitis ◽  
Acute Biliary Pancreatitis ◽  
Calot’S Triangle ◽  
Mild Acute Pancreatitis

The timing of laparoscopic cholecystectomy following an attack of acute biliary pancreatitis is controversial. The traditional approach of interval cholecystectomy has been challenged recently. The present study was designed to evaluate the benefits of interval laparoscopic cholecystectomy for patients with mild acute pancreatitis (Ranson less than 3). Nineteen patients with mild pancreatitis underwent ultrasonographic evaluation to confirm the biliary etiology. ERCP was performed in all patients on the first available endoscopy list, and endoscopic sphincterotomy was performed in two patients with calculi or dilated common bile duct on ultrasonographic examination. Medical treatment was administered and laparoscopic cholecystectomy was scheduled after 8–12 weeks to allow the inflammatory process to settle. There were no recurrent attacks of pancreatitis during this period. The degree of difficulty of the laparoscopic procedure was assessed by the presence of adhesions to the gallbladder area, difficulty of dissection in the Calot's triangle, intraoperative bleeding and the need for a drain. Six patients (31.5%) had severe adhesions, difficult dissection of the cystic duct and artery, bleeding and prolonged operating time. In two of these patients (10.5%) the procedure was converted to open cholecystectomy. In conclusion, our results suggest that postponing laparoscopic cholecystectomy in acute pancreatitis patients is not advantageous surgically and does not justify the risk of further morbidity caused by the gallbladder disease.

Optimizing the critical view of safety in laparoscopic cholecystectomy by clipping and transecting the cystic artery before the cystic duct

2007 ◽  
Vol 94 (4) ◽  
pp. 473-474 ◽  
Author(s):  
A. R. Wijsmuller ◽  
M. Leegwater ◽  
L. Tseng ◽  
H. J. Smaal ◽  
G. J. Kleinrensink ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Cystic Artery ◽  
Critical View ◽  
Critical View Of Safety

scholarly journals Laparoscopic cholecystectomy with medial segment artery mimicking cystic artery

2018 ◽  
Author(s):  
Norimitsu Okui ◽  
Yasuro Futagawa ◽  
Hiroaki Shiba ◽  
Yuichi Ishida ◽  
Katsuhiko Yanaga
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Epigastric Pain ◽  
Arterial Injury ◽  
Cystic Artery ◽  
Large Artery ◽  
Critical View Of Safety ◽  
Calot’S Triangle ◽  
Medial Segment ◽  
Aberrant Artery ◽  
Elective Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard treatment of cholelithiasis. However, LC is associated with slightly higher rate of complications than laparotomy. To perform a safe LC, it is important to exercise caution for an abnormal course of hepatic artery though the incidence itself is low. Herein, we report a rare case of LC in which medial segment artery mimicking cystic artery. To the best of our knowledge, such a case has not been reported. Case presentation: A 35-year-old male visited our hospital with a complaint of epigastric pain. The symptom had continued for two months. Ultrasound and computed tomography revealed cholelithiasis. Magnetic resonance image did not show any biliary abnormalities. The patient was scheduled for an elective laparoscopic cholecystectomy. At the time of surgery, the gallbladder was slightly inflamed. After dissection of the Calot's triangle, the cystic duct and a single large artery were identified. Though the critical view of safety was confirmed at first glance, dissection of periarterial adhesions revealed that the artery ran into the medial segment of the liver. Further dissection revealed short double cystic arteries branched from the aberrant artery. After the confirmation of all of the abnormal course of the arteries, the operation has been performed safely without arterial injury. The patient made a satisfactory recovery, and was discharged on 3 days after operation. Conclusion: The knowledge of the anatomy of the cystic artery and careful dissection are an important aspect in achieving a complication free LC.

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