ANATOMIE SI TEHNICI CHIRURGICALE - ANATOMY AND
SURGICAL TECHNIQUES
LAPAROSCOPIC ANATOMY OF THE EXTRAHEPATIC BILIARY
TRACT
E. Târcoveanu, C. Bradea, R. Moldovanu,
G. Dimofte, Oana Epure
First Surgical Clinic, „St. Spiridon” Hospital Iasi,
Research Center for Laparoscopic and Classic Surgery,
University of Medicine and Pharmacy „Gr.T. Popa” Iasi
Jurnalul de chirurgie 2005; 1 (1):92-102
Full text: Format
PDF
Abstract:
Development of mini-invasive surgery determinates a rapid improvement
in laparoscopic regional anatomy. As laparoscopy is becoming common
in most surgical departments, basic laparoscopic anatomy is mandatory
for all residents in general surgery.
Successful general surgery starts in the anatomy laboratory. Successfully
minim invasive surgery starts in the operative theatre with laparoscopic
exploration.
The initial laparoscopic view of the right upper quadrant demonstrates
primarily the subphrenic spaces, abdominal surface of the diaphragm
and diaphragmatic surface of the liver. The falciform ligament is
a prominent dividing point between the left subphrenic space and the
right subphrenic space. The ligamentum teres hepatis is seen in the
free edge of the falciform. Upward traction on the gallbladder exposes
the structures of Calot’s triangle and the hepatoduodenal ligament.
The liver is divided into anatomic segments based on internal anatomy
that is invisible to the laparoscopist. Surface landmarks include
the falciform ligament and the gallbladder fossa. The surgical procedures
performed laparoscopically currently include liver biopsy, wedge resection,
fenestration of hepatic cysts, laparoscopic approach of the hidatid
hepatic cyst, and atypical hepatectomy.
We present the laparoscopic anatomy of extrahepatic biliary tract.
Once the gallbladder is elevated, inspection reveals Hartmann’s
pouch and the cystic duct. The typical angular junction of the cystic
duct on the common duct actually occurs in a minority of patients
and the length and course of the cystic duct are highly variable.
The boundaries of Calot’s triangle are often not well seen.
The cystic artery is often visible under the peritoneum as it runs
along the surface of the gallbladder.
The variations of the structures of the hepatoduodenal ligament may
occur to injuries during laparoscopic cholecystectomy. Cholangiography
increases the safety of dissection of biliary tract by providing a
“road map” and generally precedes the dissection in cases
of anatomical variations.
Intraoperative evaluation represents a strong argument for above
dates.
KEYWORDS: LAPAROSCOPIC SURGERY, ANATOMY OF EXTRAHEPATIC BILIARY
TRACT, CALOT’S TRIANGLE, BUDDE TRIANGLE
ENGLISH
: