Anatomy of the Cystic Artery and Its Variations: Implications for Gallbladder Surgery
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Abstract
Anatomical variations of the hepatobiliary arterial supply represent a significant challenge during gallbladder surgery, as they may increase the risk of hemorrhage and bile duct injury when not recognized promptly. Among these, hepatic arterial variations described by the Michels classification are particularly relevant because of their impact on the planning and performance of hepatobiliary procedures. We present the case of a 48-year-old male patient diagnosed with acute calculous cholecystitis who underwent laparoscopic cholecystectomy. During dissection of the hepatocystic triangle, a vascular variant corresponding to Michels type V was identified, characterized by the presence of an accessory left hepatic artery arising from the left gastric artery. Intraoperative recognition of this variant allowed modification of the surgical strategy, preservation of the accessory vessel, and successful completion of the procedure without vascular or biliary complications. The postoperative course was uneventful, and the patient was discharged the following day with outpatient follow-up demonstrating no evidence of complications. This case highlights the importance of thorough knowledge of hepatobiliary vascular anatomy, the Michels classification, and the systematic application of the Critical View of Safety to reduce the risk of iatrogenic injuries during laparoscopic cholecystectomy. Furthermore, it emphasizes the importance of recognizing anatomical variations as a fundamental element for optimizing surgical safety and improving clinical outcomes.
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