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. 2019 Jul-Sep;15(3):185-191.
doi: 10.4103/jmas.JMAS_75_18.

The unwanted third wheel in the Calot's triangle: Incidence and surgical significance of caterpillar hump of right hepatic artery with a systematic review of the literature

Luigi Marano  1 , Alberto Bartoli  1 , Karol Polom  2 , Raffaele Bellochi  1 , Alessandro Spaziani  1 , Giampaolo Castagnoli  1
Affiliations

The unwanted third wheel in the Calot's triangle: Incidence and surgical significance of caterpillar hump of right hepatic artery with a systematic review of the literature

Luigi Marano et al. J Minim Access Surg. 2019 Jul-Sep.

Abstract

Background: Caterpillar hump of the right hepatic artery is a rare variation increasing the risk of vascular and biliary injuries during hepatobiliary surgery. The aim of this study is to record the cases of the right hepatic artery forming caterpillar hump in a cohort of patients underwent laparoscopic cholecystectomy and to report a review of the literature systematically conducted.

Methods: We reviewed clinical and surgical video data of 230 patients with symptomatic cholelithiasis treated with laparoscopic cholecystectomy between January 2016 and August 2017. A systematic literature search in PubMed, Medline, Cochrane and Ovid databases until 30th June 2017 was also performed in accordance with the PRISMA statement.

Results: Our institutional data indicated that 1.3% of 230 patients presented caterpillar hump right hepatic artery. The systematic review included 16 studies reporting data from a total of 498 human cadavers and 579 patients submitted to cholecystectomy. The overall proportion of surgical patients with the caterpillar hump right hepatic artery was 6.9%.

Conclusions: Variations of the cystic artery are not just an anatomical dissertation, assuming a very crucial role in surgical strategies to avoid uncontrolled vascular lesions. A meticulous knowledge of the hepatobiliary triangle in association with all elements of 'Culture of Safety in Cholecystectomy' is mandatory for surgeons facing more than two structures within Calot's triangle.

Keywords: Calot's triangle variations; Moynihan's hump; caterpillar hump of right hepatic artery; cystic artery variations; laparoscopic cholecystectomy.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Intra-operative view of the right hepatic artery caterpillar hump. CA: Cystic artery, CDS: Cystic duct stump, G: Gallbladder, CLN: Cystic lymph node, CHRHA: Caterpillar hump right hepatic artery, L: Liver
Figure 2
Figure 2
Schematic view of Figure 1. Relevant structures of the hepatic hilum and Calot's triangle are depicted. CyA: Cystic artery, CyD: Cystic duct, CBD: Common biliary duct, CHD: Common hepatic duct, GB: Gallbladder, RHA: Right hepatic artery
Figure 3
Figure 3
PRISMA flowchart of study selection
See this image and copyright information in PMC

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