Case Reports on Anatomical Variations of the Hepatic Arteries: Implications for Laparoscopic Cholecystectomy and Surgical Safety

Abstract

A laparoscopic surgeon’s understanding of embryology, anatomy, and potential anatomical variations of the bile duct is crucial for safely performing gallbladder removal using this minimally invasive technique. In conducting two medical-legal autopsies, we identified a previously undocumented anatomical variant where the liver’s blood supply originates from the common hepatic artery, branching into a trident formation to form the right, left, and cystic hepatic arteries. Notably, the right hepatic artery is situated within Calot’s triangle, whereas the cystic artery is located anomalously outside the triangle. This anatomical anomaly poses significant surgical risks, including the potential for morbidity and mortality due to ischemic necrosis of the liver from vascular injury. The success of laparoscopic surgery under these circumstances relies heavily on the surgeon’s expertise in managing an atypical surgical field, adherence to a culture of safety, and a critical approach to safety in laparoscopic cholecystectomy.