Laparoscopic anatomy of the cystic artery.

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 important. We reviewed the anatomy of the cystic artery and its variations as seen through the video laparoscope. A "normal" cystic artery was found in only 72% of patients. The most important laparoscopically noted variations were doubling of the cystic artery (22%) and an artery that ran inferior to the cystic duct (6%). Small branches of the cystic artery, which we suggest be named Calot's arteries, supply the cystic duct and may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. A scissor dissection technique was found most useful for identifying the arterial anatomy. Careful identification of arterial anomalies should help to reduce the incidence of bile duct injuries during laparoscopic cholecystectomy.