Bile duct injury, Common bile duct, Critical view of safety, Gallbladder, Laparoscopic cholecystectomy, Open cholecystectomy, Rouviere sulcus
Citation Information :
Voruganti MR, Mohammed N, Gurrala RC, Chowdary GH, Devarakonda L. Rouviere's Sulcus: Anatomy and its Clinical Significance in Laparoscopic Cholecystectomy. World J Lap Surg 2023; 16 (1):4-7.
Background: Laparoscopic cholecystectomy (LC) is associated with an increased rate of bile duct injuries than open cholecystectomy (OC). Majority of the bile duct injuries result from structural misidentification. The surgeon needs some anatomical landmarks to guide him for a safe cholecystectomy. Rouviere sulcus (RVS) is one such landmark. M Henri Rouviere first described it in 1924, but it was forgotten and neglected. It is not mentioned in anatomy or surgery textbooks. Its importance was recognized only in the late 1990s with the acceptance of LC as gold standard surgery. As there is paucity of the literature on RVS, a study was conducted on RVS.
Materials and methods: A prospective study of RVS was conducted in 130 cases of LC noting the presence, morphology, and use of the RVS in safe LC.
Results: Rouviere sulcus was present in 81.5% of cases. Open type sulcus with a horizontal direction was the most common presenting type. Rouviere sulcus is an extrabiliary landmark in a solid organ, liver, which is not affected by the gallbladder disease or retraction. It is well visualized in laparoscopic surgery than the open cholecystectomy due to opening of the sulcus by CO2 pressure and magnification of digital cameras. The cystic duct and artery lie in a safe zone ventral and anterior to the plane of RVS and the common bile duct (CBD) lies below it. Rouviere sulcus indicates a safe plane of dissection for surgeon to avoid bile duct injuries.
Conclusion: Rouviere sulcus is an important and first landmark that a surgeon must look to achieve the safe cholecystectomy and minimize bile duct injuries.
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