Anatomy and Surgical Relevance of Rouviere’s Sulcus

Abstract

Rouviere's sulcus (RS) (i.e., incisura hepatis dextra, Gans incisura) represents an important anatomical landmark. The aim of the study was to determine the frequency of the RS, its description, its location, its relations to the right portal pedicle and to the plane of the common bile duct, and the evaluation of the surgical relevance of the obtained data. Forty macroscopically healthy and undamaged livers were removed during autopsies from cadavers of both sexes. The RS was present in 82% of the cases and in these the open RS was identified in 70% of the livers. The fused type was observed in 12% of the cases; 18% of the livers had no sulcus. The mean length of the open type RS was 28 ± 2 mm (range 24–32 mm) and its mean depth was 6 ± 2 mm (range 4–8 mm). The right posterior sectional pedicle was found in the RS in 70% of the cases. In 5% of the livers, we also dissected a branch of the anterior sectional pedicle. Inside 25% of the RS, we found the vein of segment 6. The RS identification may avoid bile duct injury during laparoscopic cholecystectomy and enables elective vascular control during the right liver resection.

The anatomy of Rouviere's sulcus as seen during laparoscopic cholecystectomy: A proposed classification

“…Dahmane et al . [8] dissected 40 autopsy liver specimens and gave some details regarding the dimensions of the sulcus such as its length and breadth, and what was contained in the floor of the sulcus.…”

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

“…The presence of RGI was found in 62% of subjects, with a length between 1 and 3 cm in 66% of cases. Using the Zubair-Dahmane classification (4,8), in most situations (70%), the RGI was open-type along its entire length, and in only 30% of cases the edges of this incisura were merged along the hilum (fused type), but for no more than 1-2 cm. In nearly half of the "open" RGI cases, a glissonian pedicle could be observed.…”

“…1). When present, the Rouviere-Gans incisura (RGI) is an important anatomical mark for avoiding biliary lesions during laparoscopic cholecystectomy, for performing hepatic resections at the level of the right liver lobe, and is extremely useful in partial liver transplantation from a live donor (4)(5)(6)(7)(8)(9)(10)(11)(12).…”

Anatomía Quirúrgica y Radiológica del Hígado. Fundamentos para las Resecciones Hepáticas

“…Esta, es una de las más frecuentes de realizar. Se utiliza la incisura de Gans, surco de Rouvière, o incisura hepatis dextra como hito anatómico-quirúrgico para localizar el pedículo seccional posterior; pues esta presente en aproximadamente un 70 % de los pacientes (Reynaud et al, 1991;Dahmane et al, 2013). El drenaje venoso de esta sección es predominantemente por la vena hepática derecha, aunque se estima que en un 25 % de los casos puede ocurrir a través de una vena accesoria, directamente a la VCI (Makuuchi et al, 1985).…”