**Abstract**

Substantial knowledge of the arterial supply and its anatomical variations of the gall bladder and liver are important in all the hepatobiliary surgical procedures. The arterial supply of gallbladder called cystic artery (CA) is a vital structure required to get ligated or clipped in the path of laparoscopic cholecystectomy. The possible concerns like intra-operative bleeding or adjoining accidental injuries will almost always be focused on the research consisting of dissection and clipping with cystic artery. Pseudoaneurysm of the cystic artery has additionally been belonging to the presence of acute cholecystitis or pancreatitis. An original supply of CA is usually assessed depending on the existence of hepatic artery variants. Laparoscopic cholecystectomy is really a recent and arduous noninvasive procedure and might even result in substantial unintended effects possibly iatrogenic or in the form of post-procedural complications. The perfect knowledge of anatomy in addition to feasible variation of cystic artery is mandatory. An efficient operative strategy and consciousness are probably the key components with all the results and marginal likelihood of complications, which often can be ultimately attainable. Within this chapter, we have attempted to explore some variations of cystic artery, complications and management.

**Keywords:** cystic artery (CA), laparoscopic cholecystectomy (LC), proper hepatic artery (PHA), right hepatic artery (RHA), inferior mesenteric artery (IMA)

#### **1. Introduction**

Laparoscopic cholecystectomy (LC) is commonly used nowadays to treat numerous conditions and diseases of the gallbladder and biliary tree. It is mandatory to specialists to get acquainted with all the technique, but additionally with anatomical variants of vascular supply in the extrahepatic biliary structures [1]. The cystic artery is often a solitary blood vessel that arises from the right branch from the proper hepatic artery (PHA). It constantly goes to the hepatobiliary triangle, which is encircled superiorly with the inferior surface of the liver, inferiorly with the cystic duct and, the common hepatic duct corresponds to medially [2]. According to Calot's triangle illustration, the superior border is made with the cystic artery [2]. While getting closer to the gallbladder, the cystic artery divides into two branches superficially and deeply running on the anterior and posterior

components of the gallbladder, correspondingly. Variants at the originations and course of CA are extremely typical. Uncontrolled arterial bleeding during LC is often a significant issue and might increase the likelihood of biliary duct injury. Consequently, appropriate recognition of the anatomy of the CA is essential. Cystic artery is excessively acknowledged to possess a highly diverse branching pattern. Therefore, given that LC had become the defacto standard to treat cholelithiasis, comprehension of anatomical vascular variations in hepatobiliary surgery has attained significance [3].


**2.1 Indications**

*Essentials in Hip and Ankle*

**42**

**Figure 5.**

**Figure 4.**

*controlled trunk balancing.*

*Demonstration of the iliopsoas release techniques: (A) proximal arthroscopic transcapsular release via a central compartment approach; (B) proximal arthroscopic transcapsular release via a peripheral compartment*

*Demonstrate the stretching method of the right iliopsoas muscle/tendon. The affected hip is extended during*

*approach; and (c) distal endoscopic release at the lesser trochanteric level.*


Onur Kaygısız

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.69982

#### **Abstract**

The high rate of recurrence of urinary stones after initial treatment makes metaphylaxis essential in children. Thorough assessment and planning prior to metaphylaxis enable accurate and effective treatment. Expected benefits and possible adverse conditions must be considered when deciding on dietary restrictions in growing children, as their bone development is ongoing. A diet that includes abundant hydration and avoids salt pro‐ duces the optimal cost‐benefit ratio. When dietary modification is not sufficient, medical treatment must be added.

**Keywords:** children, diet, food, and nutrition, kidney calculi, prevention, relapse


**2. Elastic, Plastic, and Cracking Aspects of Crystal Nano-Indentations**

Figure 1 provides a background log/log compilation of indentation load, *P*, vs. surface-projected contact diameter, *d*, spanning a range from pioneering nano-indentation measurements to micro-scale indentation fracture mechanics test results obtained on silicon crystals, as identified in the top-left corner of the figure [14]. The figure was constructed to illustrate a *d*3 dependence of load for elastic contact in pioneering nano-indentation measurements made by Pethica, Hutchings, and Oliver [15], as compared with an expected *d*2 dependence for a constant material hardness; *D* is the actual or effective spherical tip diameter for each indentation. The *dc* 3/2 dependence applies for crack tip-to-crack tip measurements across the enclosed indentations.

**Figure 1.** Load, *P*, vs. either elastic contact diameter, *de*, plastic diamond pyramid diagonal, *dd*, or tip-to-tip crack length, *dc*, for silicon crystal indentations [14], and including additional cracking [16] and inset elastic-plastic spherical Berkovich-type nano-indentation measurements [17].

In Figure 1, more recently added open- and closed-ellipsoidal points [16] have covered many of the earlier data points on the *d*3/2 fracture mechanics dependence and, likewise, the inset open-square points [17] for both elastic, *de* 3, and plastic, *dp* 2, Berkovich spherically-tipped nano-indentations would have significantly overlapped the previously established hardness dependence. Thus, these points that illustrate a significant "pop-in" behavior at initial plastic yield have been shifted on the abscissa scale for clarity. Close examination of the deviation from the labeled *d*2 dependence in Figure 1 shows that an increasing hardness applies for a smaller indentation size. Calculations of the stress–strain behaviors both at the onset of plastic yielding and follow-on nano-indentation strain hardening behaviors have been reported very recently for NaCl, MgO, and copper crystals [18], tungsten crystals [19], ammonium perchlorate, and α-iron crystals [20]. Beyond the well-established determination of very high flow stress levels for initial plastic yielding, whether gradual or of pop-in type, the plastic strain hardening behavior has also been shown to be exceptionally high. The dimensionally smaller plastic deformation zones account for both higher values of initial yielding and subsequent flow on the basis of the smaller dislocation line lengths and their interactions.