New classification of the anatomic variations of cystic artery during laparoscopic cholecystectomy

AIM: To investigate the anatomic variations in the cystic artery by laparoscopy, and to provide a new classification system for the guidance of laparoscopic surgeons. METHODS: Six hundred patients treated with laparoscopic cholecystectomy from June 2005 to May 2006 were studied retrospectively. The laparoscope of 30(o)(Stryker, American) was applied. Anatomic structures of cystic artery and conditions of Calot's triangle under laparoscope were recorded respectively. RESULTS: Laparoscopy has revealed there are many anatomic variations of the cystic artery that occur frequently. Based on our experience with 600 laparoscopic cholecystectomies, we present a new classification of anatomic variations of the cystic artery, which can be divided into three groups: (1) Calot's triangle type, found in 513 patients (85.5%); (2) outside Calot's triangle, found in 78 patients (13%); (3) compound type, observed in 9 patients (1.5%). CONCLUSION: Our classification of the anatomic variations of the cystic artery will be useful for decreasing uncontrollable cystic artery hemorrhage, and avoiding extrahepatic bile duct injury.