Spiral cystic duct: beware

Laparoscopic cholecystectomy (LC) is currently the most popular operation performed for gallbladder disease. Our objective is to emphasize the superiority of the "critical view technique" over the "infundibular technique" in case of inflammation or aberrant anatomy. We present a case of a 21-year-old female who was taken to the operating room for LC. The critical view technique was performed with anterolateral infundibular retraction, and the infundibulum and body were dissected along the peritoneal reflection on both sides of the gallbladder. The cystic duct and infundibulum were funnel shaped and spiraled from lateral to posteromedial rotation. Aberrant anatomy is commonly seen during LC. We have routinely espoused the critical view technique or the use of intraoperative cholangiogram and believe that it should be applied to aid in the identification of the cystuc duct (CD). We avoid the infundibular technique, because it may be a contributing factor to common bile duct (CBD) injury.