A Lesser-Known Hepatic Anatomical and Surgical Structure: the Rouviere-Gans Incisura (RGI)

Abstract

Rouviere-Gans incisura (RGI) is a relatively frequent hepatic anatomosurgical structure (it appears in 52%-80% of cases), but it is not wellknown in hepatic surgery. The presence of RGI is an important landmark to avoid biliary lesions during laparoscopic cholecystectomy, since it allows the isolation of the right posterior glissonean pedicle in 70% of cases, therefore simplifying the resection of the posterior right hepatic section or its segments (Sg6 and Sg7). While performing a right posterior hepatic resection for living-donor liver transplantation, the presence of the RGI facilitates the dissection of the vasculo-biliary structures in the right posterior glissonean pedicle.

Expert Consensus Guidelines: How to safely perform minimally invasive anatomic liver resection

“…Most experts acknowledged named and essential structures (Laennec’s capsule, Cystic plate, Arantius plate, Umbilical plate, the Glissonean pedicle of the Caudate process, Rouviere’s sulcus) as landmarks to isolate the Glissonean pedicles during MIALR (Figure 2C). 8,13‐18 …”

Glissonean approach for hepatic inflow control in minimally invasive anatomic liver resection: A systematic review

“…Rouviere's sulcus is also reported as a useful landmark for the right pedicle (A), as frequently contents the right posterior Glissonean pedicle or G6 only (B) 35,38,82,83 …”

“…This systematic review has some limitations. Particularly, we did not perform a meta-analysis but summarized the F I G U R E 7 Rouviere's sulcus is also reported as a useful landmark for the right pedicle (A), as frequently contents the right posterior Glissonean pedicle or G6 only (B) 35,38,82,83 findings reported in the literature regarding this technique without focusing on specific topics. Future studies are necessary in order to clearly define the differences between the different Glissonean approach techniques (e.g.…”

“…To approach the right pedicles, the cystic plate (after cystic plate cholecystectomy) and the G1c are the most useful and important anatomical landmarks 14,28,30,31,35,37,42,45,47,51 . Moreover, Rouviere's sulcus is also reported as a relatively constant anatomical structure (52%-82%), easy to identify as open-type in the 70% of the cases (fused or absent in the remaining 30%) 35,38,82,83 Dissection of the Rouviere's sulcus frequently allows the isolation of the right posterior Glissonean pedicle or G6 only (early G6-G7 division), while the right anterior pedicle can be rarely identified 35,38,82,83 . (Figure 7A,B) Regarding the left pedicles, the Arantius ligament and the umbilical plate are the most important landmarks 14,19,22,27,32,46,50,53 .…”

The New Perspectives Journal of Medicine

“…outer layer, SS-OL)两部分，两层间存在疏松的组织间 隙，是常规剥离胆囊时选择进入的层次(图1)。正确进 入该间隙时，可清楚观察到SS-IL层的血管、淋巴和结缔 组织形成的网格样纤维结构，亦可游离和解剖出胆囊动脉 的浅支和深支 (5) 人群中68.1~91%的Rouvière沟是可见的。根据Zubair-Dahmane分型 (6)(7)(8) ，Rouvière沟主要分为容易辨认的瘢 痕型(scar type)、裂型(slit type)、沟槽型(groove type)；以及不易辨认的融合型(fused type)(31.87%) 与缺如(absent type)型(图4-1及4-2)。炎症粘连、肝硬 化或重度脂肪肝的病人中，Rouvière沟亦可能无法显露。 处置对策：(1)应紧贴胆囊壁松解粘连，直至显露胆 囊壶腹部及胆囊颈部右侧、背侧缘后再次判断Rouvière沟 的位置；(2)对于融合型及缺如型Rouvière沟，可参考肝 右后叶Glisson蒂切迹弧线、尾状突与下腔静脉的位置关系 判断右后叶胆管的走行平面 (9,10) 。 2.2. IV段基底部 (10) (11) 。 I型：副肝管在左、右肝管汇合部及胆囊管之间汇入肝 管；II型：副肝管在胆囊管足侧汇入胆总管，与胆囊管 有交叉；III型：胆囊管与副肝管汇合后，以共管形式汇 (11) 图5.…”