International Journal of Enhanced Research in Medicines & Dental Care, ISSN: 2349-1590 Vol. 1 Issue 10, December-2014, pp: (30-34), Available online at: www.erpublications.com Page | 30 Six anatomical landmarks for safe Laparoscopic Cholecystectomy Rachit Arora 1 , Bhavinder Arora 2 1 VMMC and SJH, New Delhi 2 MS, FIAMS, FAIS , Assoc. Professor , Department of Surgery , University of Health sciences , PGIMS, Rohtak ABSTRACT Background Laparoscopic cholecystectomy is standard for treating cholelithiasis and assessing the laparoscopic surgical skills. Identification of extra hepatic anatomy is essential to avoid biliary, vascular and visceral injuries. Material and methods The study was conducted done in one hundred patients in which laparoscopic cholecystectomy done for cholelithiasis. Six basic anatomical landmarks were identified in all patients including thirty five patients of difficult cholecystectomy. Results Identification of gall bladder and cystic duct junction, also CBD and cystic duct junction is most reliable for avoiding biliary tree injuries. Entry point of cystic artery into gall bladder is the most reliable to avoid vascular injuries. There was no incidence of extra hepatic biliary or vascular injuries in our series. Conclusion A safe laparoscopic cholecystectomy for cholelithiasis is possible if these six basic anatomical landmarks are identified. Key words Anatomical landmarks, safe cholecystectomy, laparoscopic cholecystectomy, extra hepatic biliary anatomy. INTRODUCTION Laparoscopic cholecystectomy is accepted as the standard procedure for gall stone disease. Laparoscopic cholecystectomy is associated with more biliary, vascular and visceral complications when compared with open cholecystectomy. Different anatomy in laparoscopic view of the area around the gall bladder specially the Calot’s triangle contributes to misidentification of structures. 1,2 The limited magnified view of anatomy of Calot’s triangle in laparoscopy is 2-dimensional vision as compared to 3-dimensional view in open cholecystectomy. The retraction of Hartmann’s pouch during laparoscopic cholecystectomy tends to distort the Calot’s triangle by actually flattening it rather than opening it out. 3 A clear delineation of junction of the cystic duct with gall bladder is identified by cystic node of Lund with the demonstration of a space between the gall bladder and liver clear of any other structures other than cystic artery called the safety window or critical view has already been recommend as an essential step to prevent injury during laparoscopic cholecystectomy. 4,5 After anterior dissection, the posterior dissection of the Calot’s triangle, which is popular during laparoscopic cholecystectomy, again gives a different view of the area and since the gall bladder is flipped over during this method it may lead to further anatomical distortion. 6,7 The Rouviere’s sulcus is a fissure on the liver between right lobe and caudate process and is clearly visible during a laparoscopic cholecystectomy during posterior dissection in a majority of patients. Being an extra biliary reference point it does not get affected by distortion due to pathology. 8 In view of the importance of anatomy of extra hepatic biliary system, it is logical to look at the possibility of assessing the anatomy while performing laparoscopic cholecystectomy. We describe six anatomical landmarks which must be identified during laparoscopic cholecystectomy to avoid injury to biliary ducts.