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Through which layer, between the gallbladder and the liver, does the deep branch of the cystic artery run?
Author(s) -
Honda G,
Iwasaki KI,
Matsumura H,
Kurata M,
Matsumoto H,
Horiguchi S,
Katoh I
Publication year - 2010
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/j.1758-5910.2010.00056.x
Subject(s) - medicine , gallbladder , cystic artery , cholecystectomy , layer (electronics) , artery , laparoscopic cholecystectomy , surgery , anatomy , cystic duct , chemistry , organic chemistry
During laparoscopic cholecystectomy, an enlarged field of vision increases safety and precision, but surgeons often encounter bleeding that can cause difficulties. It is important to prevent and control arterial bleeding from Calot's triangle and the liver bed that results from injury to the deep branch of the cystic artery (DBCA). However, no previous reports have mentioned the layer between the gallbladder and liver through which the DBCA runs. Materials and Surgical Technique: To determine this layer, we investigated the histological findings from consecutive thin‐slice (3 mm) blocks in six cases (three cadavers and three patients who underwent extended cholecystectomy). Results: The subserosal layer of the gallbladder wall can be divided into an inner (ss‐i) layer, which consists of abundant vasculature and some fibrous tissue, and an outer (ss‐o) layer, which consists of abundant fat tissue. DBCA runs through the ss‐o layer, far from the ss‐i layer in Calot's triangle, and runs toward the gallbladder body and ramifies into several branches that flow into the ss‐i layer. Discussion: If the gallbladder is dissected in the layer close to the ss‐i layer, as in our standardized procedure, the subbranches of DBCA are transected at the border of the ss‐i layer, and most of the DBCA is left within the ss‐o layer in Calot's triangle and the liver bed. Knowledge of the anatomy of DBCA is useful to avoid and stop bleeding from the deep part of Calot's triangle and the liver bed.