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Basic laparoscopy: Cholecystectomy 03.4 Anatomy/Cystic artery

Normal (Top left diagram)

The cystic artery is single.

It arises from the right hepatic artery.

It runs behind the common bile duct.

It runs parallel to, and 2mm. above the cystic duct.

It branches to supply the gallbladder.

It is 1 to 2mm. in diameter.

It is very fragile.

Distortion of the anatomy. (Top right diagram)

Retraction on the gallbladder often pulls a loop of right hepatic artery into view.

Variants of the cystic artery

It may be absent. (MIddle left diagram)

It may arise from a prominent arch of right hepatic artery. (Top right diagram)

It may branch early and appear to be double. (Middle right diagram)

It may run below the cystic duct.(Bottom left diagram.)

It may run just below the right hepatic duct.

It may run from the right hepatic artery in front of the

common bile duct. (Bottom right diagram)

It may arise from:

The left hepatic artery.

The superior mesenteric artery.

Accessory cystic arteries

There may be accessory cystic arteries running from:

A double right hepatic artery.

The left hepatic artery.

The superior mesenteric artery.

The gallbladder bed.

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