Visualisation of Rouviere’s Sulcus during Laparoscopic Cholecystectomy

Abstract

Introduction: Safe dissection of Calot’s Triangle is important during the performance of laparascopic cholucystectomy. The purpose of the study is to determine the frequency of demonstrable Rouviere’s sulcus in patients with symptomatic gall stones and its role in safe dissection in Calot’s triangle.
 Methods: This is a prospective descriptive study design done in Department of surgery, Kathmandu Medical College Teaching Hospital from Jan 2013 to Jan 2015. Patients who were posted for laparoscopic cholecystectomy were included. During laparoscopy, Rouviere’s sulcus was noted in the operative note and classified according to following: Type I: Open type was defined as a cleft in which the right hepatic pedicle was visualized and the sulcus was opened throughout its length. Type II: if the sulcus was open only at its lateral end. Type III If the sulcus was open only at its medial end. Type IV: Fused type was defined as one in which the pedicle was not visualized.
 Results: A total of 200 patients underwent laparoscopic cholecystectomy during period of 2 years. Out of which Rouviere’s sulcus was visualized in 150 patients (75 %).Type I (open type) was commoner in 54%, type II in 12%, Type III in 9% and type IV (fused type) in 25%.
 Conclusions: Rouviere’s Sulcus is an important extra biliary land mark for safe dissection of Calot’s triangle during laparoscopic cholecystectomy. 
 Keywords: Rouviere’s Sulcus, laparoscopic cholecystectomy, bile duct injury.

The Laparoscopic Anatomy of Rouviere’s Sulcus

“…The current study matches the abovementioned range. Thapa et al 16 reported visualized Rouviere's sulcus in of 75% of patients, Dahmane et al 8 reported an incidence of 82%, while Peti et al 7 described an incidence of 80%. The highest reported incidence of Rouviere's sulcus (> 90% visualization rate) was reported by Singh et al 12 and Kumar et al 17 In a recent meta-analysis of 23 anatomical or laparoscopic studies, Cheruiyot et al 18 reported an overall incidence of 83%.…”

Rouviere's sulcus - An anatomical landmark for safe laparoscopic cholecystectomy: A cross-sectional study

“…The Rouviere's sulcus (RS) thus can be used as a safe anatomical landmark that is present on the hilar surface of liver [ 13 ]. So, it is pertinent to know more about the anatomical details and its frequency in the population [ 14 ].…”

“…In our study, the RS was present in 169 (93.9%) and absent in 11 (6.1%) of the patients undergoing LC. Earlier studies have shown that RS is usually seen in majority of population during LC compared to open surgery [ [10] , [11] , [12] , [13] , [14] ]. Dahmane et al [ 13 ] who reported that Rouviere's sulcus was present in 82% of normal livers, and open RS was the commonest among them.…”

“…In our study, injury to the cystic artery leading to uncontrolled bleeding occurred in one case (0.15%) of the RS present group and in two cases (18.18%) of the RS absent group which was a statistically significant difference (p-value = 0.001). The visibility of RS has been considered as an important predictor in correlation with decrease in complications such as bile duct injury, major vessel injury and injury to the adjacent organ by few other studies [ [10] , [11] , [12] , [13] , [14] , [15] ]. Few other minor complications such as SSI, biloma and port site hematoma were noted among both group of patients but were managed conservatively.…”

Role of Rouviere's sulcus in identification and dissection of Calot's triangle during Laparoscopic Cholecystectomy

“…Anterior callus opening was performed in 69 cases (69%) and in at least 31 cases (31%). These are Tapa et al 14 cases of early Rovier's disease were found in 75% of the patients, Mohamed et al 15 Fifteen of them described Rover depression in 73% of the cases.…”