Hidden Anatomy Revealed: Three-dimensional Reconstruction Identifies Anomalous Right Hepatic Artery and Coiling Cystic Duct Following Difficult Cholecystectomy

Abstract Hepatobiliary anatomical variations significantly impact the safety and efficacy of biliary surgery, particularly in laparoscopic cholecystectomy, where restricted visualization increases surgical risk. One of the most challenging intraoperative scenarios is the presence of an anomalous right hepatic artery looping anterior to the gallbladder, coupled with an aberrant cystic duct and extensive fibrosis, leading to a frozen Calot’s triangle. These variations increase the risk of injury to the common hepatic duct, common bile duct, and vital vascular structures, often necessitating modifications in surgical techniques to ensure safe patient outcomes. Subtotal cholecystectomy has emerged as a salvage procedure in such complex cases, preventing catastrophic bile duct or vascular injuries and significantly reducing operative morbidity. Here, we report details about the case of a 44-year-old male who was diagnosed with symptomatic cholelithiasis and underwent laparoscopic subtotal cholecystectomy after intraoperative identification of anomalous vascular anatomy and cystic duct and severe fibrosis in the Calot’s triangle.