Rouviere’s sulcus: an overemphasized accessory sulcus or an underemphasized normal sulcus?

Ragavan, Saranya; Muraleedharan, Aparna; Bage, Nutan Nalini; Devi, Rema

doi:10.1007/s00276-020-02555-y

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…It is believed that the hilar dissection may be safely initiated by division of the peritoneum immediately ventral to the RS sulcus [ 5 – 7 ]. Data from several studies indicated that the prevalence of RS was in the range 73–90.4% [ 10 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, there are some flaws in these considerations regarding RS. Firstly, in addition to the existence of the absent type, RS would also be covered by extensive dense adhesion in complicated cases [ 9 , 23 ]. RS failed to be identified clearly in 9 cases due to severe adhesion in this study.…”

Section: Discussionmentioning

confidence: 99%

“…This definition highlights that the RS should extend from the arc incisure of the right posterior hepatic pedicle, which can help to identify some small, superficial, or narrow RS when the right hepatic pedicle is invisible in the floor of the sulcus. In addition, it is common to find one or several cracks (accessory fissures) on the visceral facies of the right liver [ 23 ]. Srimani et al reported the incidence of accessory fissures in the inferior surface of the right lobe as 27.3% [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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The hilar plane compared with the Rouviere's sulcus plane during laparoscopic cholecystectomy.

Wang¹,

Hou²,

Zhou³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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Introduction: Rouviere's sulcus (RS) has been widely used as an important landmark during laparoscopic cholecystectomy; however, some shortcomings remain unaddressed. Aim: To evaluate the safety and application values of the hilar plane in laparoscopic cholecystectomy (LC) by comparing it with the plane of Rouviere's sulcus (RS plane). Material and methods: A retrospective study of 155 consecutive patients undergoing LC used the hilar plane as a guide for surgical procedures was performed. Intraoperative images were used to evaluate and analyze the value of using the hilar plane vs. the RS plane in preventing bile duct and vascular injuries. Meanwhile, anatomical data, including the types and orientations of Rouviere's sulci, were also recorded for further analysis. Results: Rouviere's sulci failed to be identified clearly in nine cases due to severe adhesions. The prevalence of RS was 83.6% (122/146). The hilar plane was a constant landmark. The hilar plane can also form a "security dissection triangle" in the posterior triangle of the gallbladder. The hilar plane and the RS plane formed a similar triangle in 59.8% (73/122) of cases, while in other cases, the hilar plane formed a smaller dissection triangle than the RS plane due to a higher spatial position. The hilar plane had a better protective effect for avoiding ectopic hepatic ducts or ectopic right hepatic arteries injury. Conclusions: The hilar plane has the features of constant location, large coverage area, and higher location, hence being further away from the critical structures. The hilar plane on its own can provide a safe anatomic plane in some case when RS was difficult to observe or identify.

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