Evidence map›Paper›PMID 41913469›Full record

SynthesisANZ journal of surgery

Intraoperative Variations of Cystic Artery and Duct in Laparoscopic Cholecystectomy: A Systematic Review With Meta-Analysis.

George Triantafyllou, Daniel Gondorf, Dimitrios K Manatakis, Orestis Lyros, Panagis M Lykoudis, Spyridon Christodoulou, Nikolaos Arkadopoulos, Maria Piagkou

Abstract readSystematic ReviewMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in ANZ journal of surgery. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

George TriantafyllouDepartment of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.ORCID https://orcid.org/0009-0001-0122-2436
Daniel GondorfDepartment of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.
Dimitrios K ManatakisDepartment of Surgery, Athens Naval and Veterans Hospital, Athens, Greece.
Orestis LyrosFourth Department of Surgery, Attikon University Hospital, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.
Panagis M LykoudisFourth Department of Surgery, Attikon University Hospital, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.
Spyridon ChristodoulouFourth Department of Surgery, Attikon University Hospital, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.
Nikolaos ArkadopoulosFourth Department of Surgery, Attikon University Hospital, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.
Maria PiagkouDepartment of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLaparoscopic cholecystectomy (LC) is the gold-standard treatment for benign gallbladder disease but carries a higher risk of bile duct injury than the open approach, largely due to misidentification of critical hepatobiliary structures. This systematic review and meta-analysis synthesizes intraoperative evidence on the prevalence and surgical relevance of anatomical variations and evaluates their implications for safe LC.

methodsFollowing Evidence-based Anatomy and PRISMA 2020 guidelines, four databases were investigated. Random-effects meta-analyses estimated pooled prevalences and small-study effects were assessed.

resultsTwenty-seven studies (n = 9618) were included. Conventional cystic artery and duct (CA and CD) anatomy was observed in 86.15% and 89.02% of cases, respectively. Among arterial variants, duplicate CA (7.18%) and caterpillar hump of the right hepatic artery (6.26%) were the most common "third elements" entering the hepatocystic triangle. CA positional deviations included courses posterior (14.95%), anterior (10.75%), and inferior (6.23%) to the CD. Aberrant right hepatic duct entering the hepatocystic triangle was recorded in 1.03%.

conclusionsMost CA and CD variations relevant to LC occur within the hepatocystic triangle, where they can interfere with identification of the vascular-biliary pedicle and increase the risk of vasculo-biliary injury. Integrating these findings into the cognitive framework of the Critical View of Safety (CVS) highlights the importance of anticipating "third elements" and heterotopic courses when dissecting.

Indexed as

Anatomic VariationCholecystectomy, LaparoscopicCystic DuctGallbladder DiseasesHepatic ArteryHumansIntraoperative Complicationscritical view of safetycystic arterycystic ductlaparoscopic cholecystectomysurgical anatomyvariation

Identifiers

PMID41913469
PMCPMC13536192

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.