LAPAROSCOPIC DESCRIPTIONS OF COURSE, RELATION AND VARIATIONS OF CYSTIC ARTERY IN HEPATOBILIARY TRIANGLE3

Objective: To know in detail the level of origin, course and relation of the cystic artery and to assess frequency of the anatomical variations of cystic artery in hepatobiliary triangle observed during laparoscopic exposure for the guidance of laparoscopic surgeons. Study Design: It was a descriptive cross-sectional study in 6oo patients. Place and Duration of Study: This research work was undertaken in five teaching hospitals with adequate facilities and skillfull surgical team, from 8th Jan 2011-15th Jan 2014. Methadology: Surgical management of Six hundred patients with laparoscopic cholecystectomy was done from 8th April 2012 to 9th April 2014 prospectively. The Stryker, American laparoscope of 30° was employed in this study. We selected patients on the basis of non-probabilty convenient sampling technique. The DVD recorder was used to display course and relations of cystic artery and its variations on endoscopic visualization. using Medical grade video monitor was practiced to display and document anatomical variations. Photographs of each observed anatomical variation was taken. Results: Our experience with 600 laparoscopic cholecystectomies has revealed that anatomic variations of the cystic artery occur frequently. Overall results demonstrated 24% variations in the origin, course, relation of cystic artery in hepatobiliary triangle.In 76% of patients we demonstrared usual anatomy of cystic artery. Conclusion: Laparoscopic surgeons must know origin, course, relation of cystic artery and its variations to avoid vascular injuries, which can cause serious hemorrhage during laparoscopic cholecystectomy and to prevent postoperative complications. These injuries can result into significant morbidity and even mortality.