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SurgSpace / Specialties / Hepatobiliary Surgery

Hepatobiliary Surgery

Liver, biliary tree and pancreas: the most anatomy-dense corner of general surgery, where the operation is planned segment by segment on imaging before the incision, and where variant ducts and vessels are the rule rather than the exception.

4 operations in depth5 interactive cases

Backdrop: Contrast CT of the upper abdomen with multiple low-density liver metastases replacing much of the right lobe · James Heilman, MD · CC BY-SA 3.0

Surgical anatomy

Anatomy

The structures the operations walk past, and the ones they must not injure.

The structures the operations walk past, and the ones they must not injure. Real plates and photographs only; the 3D lab carries the BodyParts3D specimens.

Abdomen, biliary

Hepatocystic triangle (Calot)

The space bounded by the cystic duct, common hepatic duct, and inferior liver edge, the anatomy that decides a safe cholecystectomy.

  • Common bile duct: Clipping it instead of the cystic duct is a life-altering injury; the Critical View exists to prevent exactly this.
  • Right hepatic artery: Often loops close to the cystic artery; injury can devascularise the right liver.
  • Duodenum: Sits just below the porta, thermal injury from diathermy can present days later as a leak.
Laparoscopic cholecystectomy

Abdomen, biliary

The biliary tree & its variants

From gallbladder to ampulla: the duct system whose normal pattern is only two-thirds of patients, which is exactly why cholecystectomy has a Critical View.

  • Common bile duct: The structure every biliary operation is designed not to injure; misidentification is the field's defining catastrophe.
  • Right hepatic artery: Crosses the triangle aberrantly in about one in seven patients, hugging the cystic duct.
  • Duct of Luschka: A small subvesical duct in the liver bed; missed, it declares itself as a postoperative bile leak.
Laparoscopic cholecystectomy
The gallbladder and the bile ducts, Gray's Anatomy plate
Henry Vandyke Carter · Public domain

Danger zones

What must not be injured

  • Laparoscopic cholecystectomy

    Common bile duct

    Inflammation shortens and tents the cystic duct until the common duct can masquerade as it; the classic injury is clipping and dividing the wrong duct with complete confidence.

    Protect it: The Critical View of Safety: the triangle cleared until exactly two structures enter the gallbladder and the lower gallbladder is off its liver bed, before anything is clipped.

Open the 3D anatomy lab The danger-zone atlasSurgical approaches

Hub shaped by the Surgical Specialties Lead with the Hepatobiliary surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.