Right hepatic artery 'caterpillar hump and dual cystic arteries: relevance of critical view of safety in a 'straightforward cholecystectomy

Description

A 60-year-old woman with unremarkable medical history, underwent elective laparoscopic cholecystectomy for symptomatic cholelithiasis. A four-port technique was performed. Initial exploration of Calot's triangle was carried out by upward traction of the fundus and lateral retraction of the Hartmann's pouch; after dissection of the peritoneum medially at the level of the infundibulum, two tubular structures entering the gallbladder were visible, as usually expected. However, to obtain a 'critical view of safety',1 dissection was continued by opening up the lateral aspect of the peritoneum; hepatobiliary triangle was dissected free of areolar tissue and the bottom of the gallbladder was dissected off the lower part of the liver bed. At this stage, an anatomical variation became evident (figure 1): the right hepatic artery made a 'caterpillar-like' loop inside Calot's triangle and two short cystic arteries reached the gallbladder. According to a recent review, among clinically...

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