A prospective observational analytical study on Rouviere’s sulcus: a single institutional study
DOI:
https://doi.org/10.18203/2349-2902.isj20202389Keywords:
Identification, Rouviere’s sulcus, Safe laparoscopic cholecystectomy, TypesAbstract
Background: Laparoscopic cholecystectomy is the most commonly performed laparoscopic surgery worldwide. Safe cholecystectomy is the priority to reduce the morbidity and mortality. There is a paradigm shift from extensive Calot’s dissection to identification of Rouviere’s sulcus and lesser dissection. Identification and analysis of Rouviere’s sulcus will help us doing a safe cholecystectomy and avoiding further injuries to bile ducts.
Methods: The study included 160 cases of laparoscopic cholecystectomy, posted in elective OT and identified Rouviere’s sulcus during laparoscopy. Table visual inspection and analysis was done. And the collected data was analyzed for different types of sulcus, its position, morphology and content.
Results: Of 160 cases, 147 cases had Rouviere’s sulcus. 13 cases did not have a sulcus. Open type sulcus was present in 99 cases, 35 had closed type, whereas 19 had slit type and only 7 had a scar like sulcus. The study showed 92% of our patients had Rouviere’s sulcus and of them 61.9% had an open type which was the most common type of sulcus of them 18 cases had a visible pulsating vessel in the floor of the sulcus i.e. posterior sectional pedicle in the sulcus.
Conclusions: Present study showed, in 92% cases it is easy and approachable to visualise the Rouvier’s sulcus. So, it is feasible and beneficial to identify the sulcus and keep the dissection above this level to avoid common bile duct injury and further complication thereof.
References
Kim JK, Kim JY, Park JS, Yoon DS. Clinical significance of Rouviere sulcus during laparoscopic cholecystectomy. HPB. 2016;18:515-6.
Hunter JG. Exposure, dissection, and laser versus electrosurgery in laparoscopic cholecystectomy. Am J Surg. 1993;165(4):492-6.
Tebala GD, Innocenti P, Ciani R, Zumbo A, Fonsi GB, Bellini P, et al. Identification of gallbladder pedicle anatomy during laparoscopic cholecystectomy. Chirurgia Italiana. 2004;56(3):389-96.
Hu JX, Dai WD, Miao XY, Zhong DW, Huang SF, Wen Y, et al. Anatomic resection of segment VIII of liver for hepatocellular carcinoma in cirrhotic patients based on an intrahepatic Glissonian approach. Surgery. 2009;146(5):854-60.
Troidl H. Disasters of endoscopic surgery and how to avoid them: error analysis. World J Surg. 1999;23(8):846-55.
Olsen D. Bile duct injuries during laparoscopic cholecystectomy. Surg Endosc. 1997;11(2)133-8.
Nagral S. Anatomy relevant to cholecystectomy. J Minim Access Surg. 2005;1(2):53.
Strasberg SM, Belghiti J, Clavien PA, Gadzijev E, Garden JO, Lau WY, et al. The Brisbane 2000 terminology of liver anatomy and resections. HPB. 2000;2(3):333-9.
Lockhart S, Singh-Ranger G. Rouviere's sulcus- Aspects of incorporating this valuable sign for laparoscopic cholecystectomy. Asian J Surg. 2018;41(1):1-3.
Hugh TB. New strategies to prevent laparoscopic bile duct injury- surgeons can learn from pilots. Surgery. 2002;132(5):826-35.
Liau KH, Blumgart LH, DeMatteo RP. Segment-oriented approach to liver resection. Surg Clin. 2004;84(2):543-61.
Peti N, Moser MA. Graphic reminder of Rouviere's sulcus: a useful landmark in cholecystectomy. ANZ J Surg. 2012;82(5):367.
Singh M, Prasad N. The anatomy of Rouviere’s sulcus as seen during laparoscopic cholecystectomy: a proposed classification, J Minim Access Surg. 2017;13(2):89-95.
Dahmane R, Morjane A, Starc A. Anatomy and surgical relevance of Rouviere’s sulcus. Scient World J. 2013;2013.
Thapa PB, Maharjan DK, Tamang TY, Shrestha SK. Visualisation of Rouviere's Sulcus during laparoscopic cholecystectomy. J Nepal Med Assoc. 2015;53(199).