World Journal of Laparoscopic Surgery

Register      Login

VOLUME 16 , ISSUE 1 ( January-April, 2023 ) > List of Articles

Original Article

Rouviere's Sulcus: Anatomy and its Clinical Significance in Laparoscopic Cholecystectomy

Mohan Rao Voruganti, Nooruddin Mohammed, Ratna Chaitanya Gurrala, Gadipudi Hamika Chowdary, Lakshminarayana Devarakonda

Keywords : 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.

DOI: 10.5005/jp-journals-10033-1553

License: CC BY-NC 4.0

Published Online: 05-09-2023

Copyright Statement:  Copyright © 2023; The Author(s).


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.

  1. Rouviere H. On the configuration and the significance of groove of the caudate process. Newsletter and Memoir of the Anatomical Society of Paris 1924;94:355–358.
  2. Singh M, Prasad N. The anatomy of Rouviere's sulcus as seen during laparoscopic cholecystectomy: A proposed classification. Minim Access Surg 2017;13(2):89–95. DOI: 10.4103/0972-9941.201731.
  3. Gans H. Study of anatomy of the intrahepatic structures and its repercussions of hepatic surgery [Ph.D. thesis]. University of Nijmegen, Elsevier, Amsterdam, The Netherlands, 1955.
  4. Rafi Y, Mukhtar Z, Zaman BS. Rouviere's sulcus, A Safe Landmark for Laparoscopic Cholecystectomy. PJM HS 2018;12(4):1511–1513.
  5. Hugh TB, Kelly MD, Mekisic A. Rouviere's sulcus: A useful landmark in laparoscopic cholecystectomy. Brit J Surg 1997;84(9):1253–1254.
  6. Peti N, Moser MAJ. Graphic reminder of Rouviere's sulcus: a useful landmark in cholecystectomy. ANZ J Surg 2012;82(5):367–368. DOI: 10.1111/j.1445-2197.2012.06032.
  7. Dahmane R, Morjane A, Starc A. Anatomy and surgical relevance of Rouviere's sulcus. Sci. World J 2013;2013:254287. DOI: 10.1155/2013/254287. ISSN: 1537-744X.
  8. Wakabayashi G, Iwashita Y, Hib T, et al. Tokyo guidelines 2018 surgical management of acute cholecystitis: Safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos) J Hepatobiliary Pancreat Sci 2018;25(1):73–86. DOI: 10.1002/jhbp.517.
  9. Ewen AG, Hodson J, Vohra RS, et al. Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surg Endosc 2019;33(1):110–121. DOI: 10.1007/s00464-018-6281-2.
  10. KH Al-Naser M. Rouviere's sulcus: A useful anatomical landmark for safe laparoscopic cholecystectomy. Int J Med Res Health Sci 2018;7(1):158–161. ISSN: 2319-5886.
  11. Kumar A, Shah R, Pandit N, et al. Anatomy of Rouviere's sulcus and its association with complication of laparoscopic cholecystectomy. Minim Invas Surg 2020;3956070:7. DOI: 10.1155/2020/3956070.
  12. Zubair M, Habib L, Memon F, et al. Rouviere's sulcus: A guide to safe dissection and laparoscopic cholecystectomy. Pakistan J Surg 2009;22(2):119–121.
  13. Abdelfattah MR. The laparoscopic anatomy of Rouviere's sulcus. Open Access Surg 2021;14:67–71. DOI:10.2147/OAS.S341710.
  14. Cheruiyot I, Nyaanga F, Kipkorir V, et al. The prevalence of the Rouviere's sulcus: A meta-analysis with implications for laparoscopic cholecystectomy. Clin Anat 2021;34(4):556–564. DOI: 10.1002/ca.23605.
  15. Lockhart S, Singh-Ranger G. Rouviere's sulcus – Aspects of incorporating this valuable sign for laparoscopic cholecystectomy. Asian J Surg 2016;41(1):1–3. DOI: 10.1016/j.asjsur.2016.07.012.
  16. Gupta V, Jain G. Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy World J Gastrointest Surg 2019;11(2):62–84. DOI: 10.4240/wjgs.v11.i2.62.
  17. Iwashita Y, Hibi T, Ohyama T, et al. Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: An evolutionary cul-de-sac or the birth pangs of a new technical framework? J Hepatobiliary Pancreat Sci 2017;24(11):591–602. DOI: 10.1002/jhbp.503.
  18. Greene B, Tsang M, Jayaraman S. The inferior boundary of dissection as a novel landmark for safe laparoscopic cholecystectomy. HPB (oxford) 2021;23(7):981–983. DOI: 10.1016/j.hpb.2021.02.004.
  19. Deng SX, Zhu A, Tsang M, et al. Staying safe with Laparoscopic cholecystectomy: the use of landmarks and intraoperative timeouts. Art Surg 2021;5. DOI: 10.21037/aos-21-1.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.