Laparoscopic cholecystectomy (LC) is among the most common general surgical procedures performed globally and has become the preferred method for treating symptomatic cholecystolithiasis, as well as chronic and acute cholecystitis. While this approach offers benefits such as quicker recovery and improved aesthetic outcomes, it does carry a higher risk of complications. These include hemorrhage, surgical site infections, respiratory problems, trocar-related damage to internal organs, major blood vessel injuries, and bile leakage. Despite surgeons having completed their learning curves and implemented preventive measures to avoid ductal or vascular injuries during LC, the rate of serious complications has not decreased [1]. This suggests that although most surgeons have reached a plateau in their skills, there has been no notable reduction in complication rates. Furthermore, bile duct or vascular system injuries following LC tend to be more complex than those occurring after open surgery, leading to significant morbidity and potential fatality. LC-associated vascular injuries are common, especially those impacting the right hepatic artery or causing lengthwise narrowing of the common bile duct (CBD) following unsuccessful repair efforts. Bile duct strictures and biliary leakage are serious long-term consequences of LC, associated with high rates of morbidity, mortality, and extended hospital stays. Various factors can lead to catastrophic iatrogenic incidents during LC, including anatomical variations, patient characteristics, gallbladder disease, surgical approach, and surgeon’s expertise. Research has shown that the majority of biliary or vascular injuries (71%–97%) result from mistakes in visual perception or interpretation [2]. Anatomical factors, particularly the numerous variations in the biliary tract structure, pose a potential risk for iatrogenic damage. These variations include different cystic duct configurations, such as a short cystic duct, one that runs parallel to the CBD, abnormalities of the cystic duct/common hepatic duct junction, the presence of a hepatocytic duct or an accessory cystic duct, and the occurrence of aberrant bile ducts.

A recent study titled “Rare anatomical variants encountered during laparoscopic cholecystectomy in low resource conditions and the convenient concept of the safe zone of dissection: a prospective observational study at a single center” [3] warrants consideration. This research identifies and categorizes the anatomical variations observed during LC, while establishing the safe zone of dissection. Additionally, it examines regional biliary and vascular variations. The study is particularly valuable as it documents significant anatomical variations encountered during actual cholecystectomy procedures, which are frequently performed. While previous research has described anatomical structures in cadavers, this study is considered more relevant because of its focus on abnormal structures observed during live surgeries. Although LC may appear straightforward, it can present numerous challenges with potentially severe complications. Consequently, accurate anatomical interpretation is crucial for successful biliary surgery.

Conflict of interest

The author has no conflicts of interest to declare.

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