N.M., a 49-year-old female, was admitted with acute abdominal pain, fever, leukocytosis and thickened gallbladder containing stones on ultrasound. The gallbladder was found to be inflamed and edematous at time of surgery. Dissection within the triangle of Calot demonstrated venous structures between the later confirmed cystic duct and artery (Figure 3). Cholecystectomy proceeded uneventfully.
Early in our experience with laparoscopic cholecystectomy, the presence of small tubular structures within the triangle of Calot became evident as being necessarily divided to proceed with the dissection. Among these was a structure that presented as a bridge between the cystic artery and duct; the division of which, unless controlled, resulted in insignificant but annoying bleeding. It quickly became a standard part of the procedure to clip or cauterize this ves sel during the dissection. Its color and non-pulsatile bleeding when divided, indicated that this was a vein, ostensibly unnamed. Further experience established the presence of other veins consistently present within the triangle. It was subsequently determined that these venous channels were named as the cystic veins and their courses documented in early textbooks of anatomy.