Morphological study of rouviere's sulcus: An important landmark in laparoscopic cholecystectomy and right segmental liver resection

Abstract

Background: Rouviere's sulcus (RS) is a cleft, on the inferior surface of the liver, extending from the caudate process to the right lobe for a variable distance. Cystic duct and artery lie anterosuperior while the common bile duct lies anterior to this sulcus, making it an important landmark in laparoscopic cholecystectomy. Being situated anterior to segment I of liver and having the right posterior portal pedicle as its frequent content, it is an important guide in right segmental liver resection. This study intends to study the anatomy of the RS. Methodology: The present study was done by analyzing 60 formalin-fixed adult livers, for the presence/absence of RS, its morphology and morphometry. Results: RS was present in 49 (81.66%) specimens, it was oblique in 26 (43.33%), transverse in 23 (38.33%) and absent in 11 (18.33%) specimens, RS was classified into three different types - type 1, type 2, and type 3 based on its degree of penetration into the substance of the liver. Type 1, defined as a deep sulcus was present in 37 (61.66%) specimens. Type 2, a slit-like shallow sulcus was observed in 7 (11.66%) and type 3, scar-like sulcus was observed in 5 (8.33%) of specimens. The average length of RS was 2.84 cm, breadth was 0.18 cm and the average depth of the RS was 0.62 cm. Conclusion: RS is an important extra-biliary landmark of the liver, that could easily be visualized during laparoscopic hepatobiliary surgeries and its identification could definitely reduce the risk of bile duct and vascular injuries during these surgeries. Hence, the in-depth knowledge about the anatomy of RS which is less studied and not included in anatomy literature is essential.