Laparoscopic cholecystectomy is the gold standard treatment for cholecystitis and cholelithiasis. But such minimal access surgery requires accurate knowledge of the structures in and around the calot’s triangle. One of the structure is the cystic artery, which presents a lot of variation in this region. Ignorance of the variations of this structure during L.C. causes problematic haemorrage and unnecessary conversion to open cholecystectomy. This study tries to find the variations of distribution of the cystic artery in relation to the CHD and tries to compare it with that found during, Laparoscopic cholecystectomy. The findings are compared with other previous studies.

Keywords: Laparoscopic cholecystectomy, cystic artery, common hepatic duct, Calot’s triangle.

1. Nuri A, Kama MK, Reis E, Atli M., Dolapci M. Risks Score for conversion from Laparoscopic to open cholecyste-comy. The Americal Journal of Surgery.2001;181:520-5.
2. Singh K,  Ohri  Laparoscopic cholec-ystectomy. Is there a need to convert?. J Min   Access. Surg. (2005);1:52-59.
3. Sahu SK, Agrawal A, Sachan PK. Jurnalul de chirurgie (Iaşi)(2013),Vol 9;Nr 2:149-156.
4. Torres K ,chrościcki A, Goloxka A,Torres A., Staśkiewicz G, Palczak R, Ceja-Sanchez J M , Ceccarorii M, Drop A. The Course of the cystic artery during laparoscopic cholecystectomy . Folia Morpho l (Waroz).(2009)Aug;68(3):140-3.
5. Abdalla S., Pierre S., Ellis H, Clir. Anat.(2013)May;26(4):493-501. doi:10.1002/ca.22170.Epub 2013 Mar 21.
6. Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice.40^th New York; Elsevier.
7. Hollinshead NH. Anatomy for surgeons: The Thorax, Abdomen and Pelvis.2^nd New York ; Harper and Row:1971.
8. Rocko JM, Swan KG, DiGioia JM:” Calot’s Triangle revisited “. Surgery, Gynecology & Obstetrics;(1981) Vol.153, no.3.:410-414.
9. Sabiston Textbook of Surgery. The Biological Basis of Modern Surgical practice.18^thd. Philadelphia. Saunders/ Elsevier:2018.
10. Bahlooli A, Hadi S et al. Conversion rate of laparoscopic to open cholecystectomy. YEMENI JOURNAL FOR MEDICAL SCIENCES,[S.I.](Dec.2009);3:3 .ISSN-227-961x.
11. Huang ZQ, Huang XQ. Changing Patterns of traumatic bile duct injuries .A review of forty years experience. World J Gastroenterol (2002);8:5-12.
12. Veen EJ,Bik M,Janssen-Heijnen ML,De Jough M,Roukema AJ.Outcome measure-ment in laparoscopic cholecystectomy by using a Prospective complication registry. Results of an audit.Int J Qual Healthcare (2008);20:144-51.
13. Way HW,Stewart L,Hunter JG.”Causes and prevention of laparoscopic bile duct injuries”. Ann.Surg.(2003) Apr;237(4): 460-69.
14. Singh K,Ohri H. Anatomical landmarks: their usefulness,in safe laparoscopic cholecystestomy.(2006) Surg.Endosc ;20:1754-1758.
15. Nagral S.Anatomy relevant to cholecystectomy.J minim Access Surg.(2005);1(2):53-58.
16. Desilva M.,Ferriando D. . Anatomy of the Calot’s triangle and its relevance to laparoscopic cholecystectomy. Ceylon med J(2001) mar:46(1):33-4.
17. Hugh TB, Kelly MD, Li B.Laparoscopic anatomy of cystic artery.Am J.Surg.1992. June;163(6):593-5.
18. Mlakar B.,Gadzijev EM,Ravnik D, Hriberni KM. Anatomical Variations of the cystic artery.Eur J Morphol. 2003Feb;41(1):31-4.
19. Chen TH.,Shyu JH,Chen CH, et.al. Variations of the cystic artery in Chinese adults. Surg .Laparosc Percntan Tech .2000;10(3):154-157.
20. Kholdebarin R,Boetto J,Haruish JL, Urbach DR .Risk factors for bile duct injury during laparoscopic cholecystec-tomy: a case-Control study.Surg Innov. 2008;15(2):114-119
21. Flisińsici P, Szpinda M, Flisiriski M.The cystic artery in human fetuses.Folia Morphol;Vol.63,No.1 : 47-50.
22. Ahmed MK, Slylvia S.Origin of cystic artery and its position in relation to biliary ducts and calot’s triangle . Journal of Evolution of Medical and Dental Sciences(2015);Vol.4;issue01,January 01:1-5.DOI:10.14260/jemdo/2015/,.
23. Toonli J. Surgery of the biliary to tract . New York;Churchill hivingstone:1993.
24. Balija M, Huis M,Nikolic V,stulhofer M.Laparoscopic visualization of the cystic artery anatomy.World J Surg.1999 Jul;23(7):703-7,discussion 707.
25. Suzuki M,Akaishi S,Rikiyama T,Naitoh T,Rahman M M,Matsuno S (2000). Laparoscopic cholecystectomy , Calot’s triangle, and variations in cystic arterial supply.Surg.Endosc;14:141-144
26. Michels NA. The hepatic,cystic and retro duodenal arteries and their relatiors to the biliary ducts with samples of the entire Coeliacal blood supply. Ann. Surg. (1951);33:503-524.
27. Rashid A, Mushtaqe M, Bali RS , Nazir S,Suhail K and Ishaq S. Artery to cystic duct.A Consistent branct of cystic artery seen in laparoscopic cholecystectomy. Anatomy Research International (2015); Article I D 847812:3 .http://dx.doi.org/10.1155/2015/847812.

Satyashree Ray

S.C.B. Medical College and Hospital, Cuttack, Odisha, 753007, India