Real versus apparent appearance of shortened cystic duct fused with the common bile duct

The deception of the hidden cystic duct and the infundibular technique of laparoscopic cholecystectomy.

(A) Appearance to surgeon when a duct appearing to be the cystic duct is dissected first. Note that the duct appears to flare (heavy black line), giving the appearance that the cystic duct has been followed onto the infundibulum.

(B) True anatomic situation in the case of some classical injuries. The "flare" (heavy black line) is from the separation of the cystic and common hepatic ducts or the side of the common hepatic duct and the side of the gallbladder. Note that such a deception is impossible if the dissection is carried to the "critical view" rather than relying on the "infundibular" technique before dividing any structures.