The right hepatic artery arises from the proper hepatic artery and supplies the right hepatic lobe (segments V, VI, VII, VIII) and typically gives rise to the cystic artery to the gallbladder. It passes posterior to the common hepatic duct before entering the liver at the right hepatic pedicle. In approximately 15-20% of individuals a replaced or accessory right hepatic artery arises from the superior mesenteric artery and passes posterior to the portal vein.
The right hepatic artery and its cystic artery branch are the central structures in the critical view of safety during laparoscopic cholecystectomy. The medial wall of the cystic duct and the lower edge of the right hepatic artery define the hepatocystic triangle (Calot triangle). Misidentification of the right hepatic artery as the cystic artery is a rare but catastrophic bile duct injury complication. A replaced right hepatic artery from the SMA passes in the Calot region and must be identified to prevent its ligation during cholecystectomy.
Misidentification of the right hepatic artery in the hepatocystic triangle during laparoscopic cholecystectomy, particularly when it courses close to the cystic duct, leads to hepatic artery ligation and right lobe ischaemia; achieving the critical view of safety with dissection of the hepatocystic fat before clipping prevents this catastrophic injury.
A right hepatic artery arising from the SMA in 15-20% of individuals passes posterior to the portal vein and through the Calot triangle region, creating a vulnerable structure during right hepatectomy, pancreaticoduodenectomy, and cholecystectomy that must be identified on preoperative CT angiography.
