Madany Triangle is Safe in Case with Caterpillar Hump of Rt Hepatic Artery
Case description
Madany triangle is safe as a critical view of safety even in a case with Caterpillar hump of Rt hepatic artery. We abolish the seat belt effect of the cystic artery and its branches on the proximal part of the GB, infundibulum, and cystic duct. Using diathermy (monopolar for small branches while the bipolar for the main cystic artery and the large branches if present), we skeletonize these parts to achieve the Madany triangle safely away from this Caterpillar hump of the right hepatic artery. As we know “fundus first” approach is safer in dissecting the area we call Calot’s triangle, but its disadvantage is the proper retraction of the liver with the fundus can’t be achieved. Madany triangle has the advantage of fundus first approach without this disadvantage.
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