Rouviere’s Sulcus: A Guide to Safe Laparoscopic Cholecystectomy

Abstract

Purpose: Rouviere’s sulcus (RS) serves as an important anatomical landmark to avoid bile duct injuries during a laparoscopic cholecystectomy. However, there is significant paucity in literature regarding its surgical importance during laparoscopic surgeries. The aim of this study was to identify cases where RS was identified before dissection of the Calot’s triangle.Methods: For this retrospective observational study, 500 patients who underwent a laparoscopic cholecystectomy at our hospital and who were operated on between September 2017 to August 2022 were reviewed. Identification of RS and its types were analyzed.Results: Among all 500 cases, RS was present in 465 (93%) cases whereas it was absent in only 35 (7%) cases. RS was present in different forms of cholelithiasis. Open, closed, slit like, and scar type of RS was found in 75.29%, 12.90%, 3.21%, and 8.20%, respectively. Identification of RS along with achieving a critical view of safety in antero-superior direction to RS resulted in no injury to the bile duct in all 465 cases.Conclusion: Identification of RS along with achieving a critical view of safety should be the aim in all laparoscopic cholecystectomy procedures. The RS is as an important landmark to reduce biliary tract injuries.