A gallbladder with the "hidden cystic duct": A brief overview of various surgical techniques of the Calot's triangle dissection

Abstract

We present a case of a middle-aged female who attended for a routine laparoscopic cholecystectomy as a day case surgery. At operation, she was found to have a distended gallbladder with an unusually prominent distal portion. This has made the dissection of the Calot's triangle challenging. As a result, the "critical view of safety" technique was applied. This allowed for the clear Calot's triangle visualization and identification of the cystic duct and artery. This case highlights that the knowledge of various ways of the cystic duct dissection is essential to every surgeon. Furthermore, this helps to adjust the dissection approach on an individual case bases ensuring avoidance of the common bile duct injuries.

Keywords: Calot’s triangle; common bile duct injury; critical view of safety; intraoperative cholangiography; laparoscopic cholecystectomy; “hidden cystic duct”.

Conflict of interest statement

Conflict of interest: The authors declared that they have no conflict of interest.

Figures

Fig. 1.

The gallbladder with an unusually prominent distal portion

Fig. 2.

The “critical view of safety” window